title: Management of clinical stage I nonseminomatous germ cell testicular cancer.
abstract: The optimal management of patients who have clinical stage I nonseminomatous germ cell tumors remains controversial. Surveillance, retroperitoneal lymph node dissection (RPLND), and chemotherapy with two cycles of bleomycin-etoposide-cisplatin are established treatment options and all are associated with long-term cancer control rates of 97% or greater. Studies have consistently identified the presence of lymphovascular invasion and a predominant component of embryonal carcinoma in the primary tumor as risk factors for occult metastatic disease in these patients. Patients who do not have these risk factors are optimally managed by active surveillance given the low risk for relapse. For patients at high risk for relapse and who are not candidates for surveillance, we believe the evidence supports RPLND over primary chemotherapy.
authors.affiliation: Department of Solid Tumor Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland, OH 44195-0001, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stephenson
authors.forename: Timothy
authors.initials: T
authors.lastname: Gilligan
authors.forename: Eric A
authors.initials: EA
authors.lastname: Klein
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D017024:Chemotherapy, Adjuvant; D006063:Chorionic Gonadotropin / Q000097:blood; D002986:Clinical Trials as Topic; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D007770:L-Lactate Dehydrogenase