Testicular Cancer: Risk Factors and the Role of Adjuvant Chemotherapy

Abstract

Advances in therapeutic results due to chemotherapy in metastatic non‐seminomatous germinal cell tumors of the testes are stimulating investigations that assess the role of chemotherapy as an adjuvant to surgery and/or radiotherapy in early stages of disease. In current series, complete responses are obtained in 70–80% of patients with metastatic disease; the relapse rate is 15–20%. Toxicity is significant but acceptable. The current literature reveals that surgery and/or radiation to the periaortic lymph nodes for clinical Stage I disease results in a 2+ year disease‐free survival rate of about 90%. For clinical Stage II disease, the rate is about 50%. Patients with non‐seminomatous testicular carcinoma Stage II are at significant risk to develop distant metastases and are candidates for an intergroup protocol that randomizes patients to receive either adjuvant combination chemotherapy or combination chemotherapy at first recurrence. All patients with testicular cancer should be considered curable. This requires careful assessment and monitoring, and can best be approached in controlled clinical trials.