No Adjuvant Chemotherapy in Selected Patients with Pathologic Stage II Nonseminomatous Germ Cell Tumors of the Testis

Abstract

In a previous report on patients with resected stage II nonseminomatous germinal cell testis tumors the findings of retroperitoneal metastases larger than 5 cm, macroscopic extranodal spread and tumor invasion into retroperitoneal veins (pathologic stage IIC) almost invariably were associated with relapse and poor survival in the absence of adjuvant chemotherapy, while postoperative cisplatin, vinblastine and bleomycin therapy was effective in preventing relapses in all cases. From Feb. 1980-Jan. 1982, 40 consecutive patients underwent retroperitoneal lymphadenectomy for stage II disease. Only patients with pathologically assessed stage IIC cancer received 4 cycles of adjuvant cisplatin, vinblastine and bleomycin, while those with pathologic stages IIA and IIB disease, with or without microscopic extracapsular extension of the tumor, received no further therapy and were followed carefully at monthly intervals. After a median follow-up of 26 mo. or more, relapses were noted in none of the 14 treated patients compared to 9 of 26 untreated patients (35%). Of the latter 9 patients, 8 (89%) had continuous complete remission after salvage therapy and 39 of 40 patients (97.5%) currently are free of disease. No difference was observed in the relapse rate and survival between patients with stages IIA and IIB disease. Apparently, patients with pathologic stages IIA and IIB disease can be treated safely only at the time of relapse, while the usefulness of adjuvant chemotherapy was confirmed in those with stage IIC cancer.