High-risk clinical stage I nonseminomatous germ cell tumors: the case for chemotherapy.
Testis cancer is the most frequent solid malignancy in young men. The majority of patients present with clinical stage I disease and about 50% of them are nonseminomatous germ cell tumors. In this initial stage of disease there is a subgroup of patients at high risk with a likelihood of more than 50% for relapse. Treatment options for these patients include: retroperitoneal lymph node dissection (RPLND), albeit 6-10% of patients will relapse outside the field of RPLND, active surveillance with even higher relapse rates and adjuvant chemotherapy. As most of these patients have the chance to become long-term survivors, avoidance of long-term side effects is of utmost importance. This review provides information on the potential of chemotherapy to achieve a higher chance of cure for patients with high-risk clinical stage I disease than its therapeutic alternatives and addresses toxicity and dose dependency.
Westermann
Dirk H
DH
Department of Urology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany.
Studer
Urs E
UE
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009362:Neoplasm Metastasis / Q000517:prevention & control; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000601:surgery; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery