title: The management of patients with nonseminomatous germ cell tumors of the testis with serologic disease only after orchiectomy.
abstract: Management of patients with nonseminomatous germ cell tumors of the testis who have persistently elevated serum tumor marker levels (alpha-fetoprotein and/or human chorionic gonadotropin) following orchiectomy and no clinical evidence of disease is controversial. We reviewed our experience with 15 such patients at our cancer center between March 1977 and November 1991. Group 1 (11 patients) underwent initial retroperitoneal lymph node dissection and group 2 (4 patients) received primary chemotherapy. All group 1 patients required subsequent chemotherapy for retroperitoneal disease or persistent marker elevation, whereas only 1 of the 4 who received primary chemotherapy required later surgery. We conclude that tumor marker elevation in this setting is usually indicative of systemic tumor, which is best treated primarily by initial chemotherapy.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: B E
authors.initials: BE
authors.lastname: Davis
authors.forename: H W
authors.initials: HW
authors.lastname: Herr
authors.forename: W R
authors.initials: WR
authors.lastname: Fair
authors.forename: G J
authors.initials: GJ
authors.lastname: Bosl
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D006063:Chorionic Gonadotropin / Q000097:blood; D003131:Combined Modality Therapy; D018237:Germinoma / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008197:Lymph Node Excision; D008297:Male; D009919:Orchiectomy; D013736:Testicular Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000601:surgery; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D007770:L-Lactate Dehydrogenase