Retroperitoneal lymphadenectomy and aggressive chemotherapy in nonbulky clinical stage II nonseminomatous germinal testis tumors

Between January 1985 and December 1990, 208 consecutive patients underwent retroperitoneal lymphadenectomy (RPLND) for low-stage (negative imaging or retroperitoneal disease up to 3 cm) non-seminomatous germ cell testicular tumors. Before RPLND, patients were staged with computed tomography (CT) or magnetic resonance imaging (MRI) of abdomen and pelvis, alpha-fetoprotein (AFP) and beta submit of human chorionic gonadotropin (b-HCG) assay. Lymphangiography (LAG) was performed in 139 cases. Out of 208, 173 (83%) patients belonged to clinical stage I, 21 (10%) to clinical stage II-A (retroperitoneal disease up to 2 cm) and 14 (7%) to clinical stage ll-B (retroperitoneal disease from 2 to 3 cm). Before RPLND, serum markers AFP and b-HCG were pathological in 16 (9%) of 173 patients in clinical stage I, in 7 (33%) of 21 in clinical stage ll-A and in 6 (43%) of 14 in clinical stage ll-B < 3 cm. Retroperitoneal metastases were pathologically found in 46 (27%) of 173 patients in clinical stage I, in 15 (71%) of 21 in clinical stage ll-A and in all 14 clinical stage ll-B < 3 cm. As many as 31 (20%) of 157 in clinical stage I with negative markers and only 8 (57%) of 14 clinical stage II-A with negative markers had retroperitoneal metastases. The low reliability of clinical staging enforces RPLND as the most accurate staging procedure for marker negative clinical stage I and II-A patients.

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Paternity in men with stage I testis tumors on surveillance.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.2.733 ◽

1998 ◽

Vol 16 (2) ◽

pp. 733-734 ◽

Cited By ~ 30

Author(s):

H W Herr ◽

N Bar-Chama ◽

M O'Sullivan ◽

P C Sogani

Keyword(s):

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Retroperitoneal Lymph Node Dissection ◽

Nerve Sparing ◽

Testis Tumor ◽

Fertility Potential ◽

Testis Tumors ◽

Nonseminomatous Germ Cell Tumors

PURPOSE We report long-term paternity in men with stage I testis tumors who were managed initially by surveillance. PATIENTS AND METHODS One hundred five patients with clinical stage I nonseminomatous germ cell tumors of the testis were entered on a surveillance protocol and followed up for more than 10 years. Actual fertility potential was assessed by pregnancy. RESULTS Of the 105 patients, 41 (39%) have fathered children, which includes 36 of 78 (46%) patients while on active surveillance and five of 27 (19%) patients after treatment for relapse. Of 63 couples who attempted a pregnancy on surveillance or were presumed capable of impregnation (whether they tried or not), 41 (65%) were successful. CONCLUSION These results show that the majority of men with stage I testis tumor who are on surveillance after orchiectomy, have a suitable partner, and attempt impregnation achieve a successful pregnancy. Pregnancy rates appear to be less than reported in men who have a nerve-sparing retroperitoneal lymph node dissection (RPLND) because more patients on surveillance require treatment for relapse, which reduces their chances for pregnancy.

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