Abdominal relapse in stage 1 nonseminomatous germ cell tumours of the testis managed by surveillance or with adjuvant chemotherapy.
OBJECTIVE
To assess the impact on patterns of recurrence of adjuvant chemotherapy in patients with stage 1 nonseminomatous germ cell tumours (NSGCT) of the testis, who have a high likelihood of relapse on surveillance if certain risk factors are identified in the orchidectomy specimen, and thus the theoretical need for retroperitoneal lymph node dissection (RPLND).


METHODS
The incidence of abdominal relapse was recorded in 417 men presenting with stage 1 NSGCT over the past 18 years. Up to 1986, 161 men were managed by surveillance alone, and abdominal relapse occurred in 26. From 1986 onwards, men with positive risk factors in the orchidectomy specimen were offered two courses of chemotherapy; 60 accepted and one relapsed in the abdomen, and 196 underwent surveillance and 19 relapsed in the abdomen.


RESULTS
Abdominal relapse was significantly reduced from 16% before 1986 to 8% afterward (P = 0.014). Mortality from testicular tumour or treatment toxicity remained low, at 0.6% before 1986 and 2.0% since then.


CONCLUSIONS
The need for RPLND in stage 1 NSGCT remains highly doubtful.
Hendry
W F
WF
Testicular Tumour Unit, Royal Marsden Hospital, London and Surrey, UK.
Norman
A
A
Nicholls
J
J
Dearnaley
D P
DP
Peckham
M J
MJ
Horwich
A
A
D000008:Abdominal Neoplasms / Q000556:secondary*; D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods; D018239:Seminoma / Q000188:drug therapy* / Q000556:secondary*; D013736:Testicular Neoplasms / Q000188:drug therapy*