title: Controversies in the management of stage 1 non-seminomatous germ cell tumors.
abstract: Post-orchiectomy treatment for clinical stage 1 non-seminomatous germ cell tumors (NSGCT) remains highly debated. Cure rates for testicular germ cell tumors exceed 99 % in early stage disease despite the lack of consensus regarding post-orchiectomy treatment. The controversy relates to the challenge of identifying those patients with clinical stage 1 (CS 1) NSGCT who are most likely to benefit from adjuvant therapies. Established post-orchiectomy treatment options for CS 1 NSGCT include observation, adjuvant chemotherapy and retroperitoneal lymph node dissection. Effective salvage therapies allow for cure rates which approach 100 % for each of these options. The data suggest that low-risk CS 1 NSGCT can be treated with surveillance and consideration for all three options is necessary for high-risk patients. The data show that high-risk patients are those whose disease pathology demonstrates lymphovascular invasion. The decision regarding post-orchiectomy treatment should be based on a discussion with the patient and the specific expertise of the treating institution.
authors.affiliation: Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH, 44195-0001, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Coleman
authors.forename: Andrew
authors.initials: A
authors.lastname: Stephenson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D019468:Disease Management; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000175:diagnosis / Q000556:secondary / Q000628:therapy; D009919:Orchiectomy; D012187:Retroperitoneal Space; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
references.citation: Eur J Cancer. 1995 Sep;31A(10):1599-604
references.pmid: 7488408
references.citation: J Urol. 1995 Nov;154(5):1759-63
references.pmid: 7563341
references.citation: Urology. 2011 Oct;78(4 Suppl):S444-55
references.pmid: 21986224
references.citation: J Clin Oncol. 1992 Nov;10(11):1762-8
references.pmid: 1403057
references.citation: J Clin Oncol. 2000 Jan;18(2):358-62
references.pmid: 10637250
references.citation: J Urol. 1990 Nov;144(5):1160-3
references.pmid: 2172569
references.citation: Onkologie. 2011;34(4):173-6
references.pmid: 21447974
references.citation: Indian J Urol. 2010 Jan-Mar;26(1):72-5
references.pmid: 20535290
references.citation: J Clin Oncol. 1988 Sep;6(9):1467-73
references.pmid: 2843611
references.citation: Cancer. 1998 Sep 1;83(5):1002-11
references.pmid: 9731905
references.citation: J Clin Oncol. 2007 Apr 10;25(11):1310-5
references.pmid: 17416851
references.citation: J Clin Oncol. 2003 Nov 15;21(22):4092-9
references.pmid: 14559885
references.citation: J Natl Cancer Inst. 2009 Dec 16;101(24):1682-95
references.pmid: 19940282
references.citation: J Urol. 2004 Jan;171(1):172-6
references.pmid: 14665870
references.citation: J Urol. 2000 Jun;163(6):1721-4
references.pmid: 10799168
references.citation: Eur Urol. 2010 Dec;58(6):912-8
references.pmid: 20817343
references.citation: APMIS. 2003 Jan;111(1):76-83; discussion 83-5
references.pmid: 12752240
references.citation: World J Urol. 2009 Aug;27(4):441-7
references.pmid: 19609532
references.citation: J Clin Oncol. 2010 Jan 1;28(1):119-25
references.pmid: 19917846
references.citation: J Urol. 2005 Aug;174(2):557-60; discussion 560
references.pmid: 16006891
references.citation: J Clin Oncol. 2001 Apr 1;19(7):2020-5
references.pmid: 11283135
references.citation: N Engl J Med. 1987 Dec 3;317(23):1433-8
references.pmid: 2446132
references.citation: J Urol. 2009 Feb;181(2):627-32; discussion 632-3
references.pmid: 19091344