Results of adjuvant chemotherapy for low-stage nonseminomatous germ cell tumors of the testis with vascular invasion.

Vascular invasion has been well established as one of the prime prognostic indicators in nonseminomatous germ cell tumors of the testis (NSGCT). In a retrospective series of node negative or minimally involved patients by radiology, only eight of 28 (28.6%) survived when vascular invasion was detected, compared with 50 of 72 (69%) without vascular invasion. In 1977 a policy of adjuvant cytotoxics (vinblastine and bleomycin) was added to the radiotherapy which was standard postorchidectomy treatment at the Peter MacCallum Cancer Institute. When platinum-based combination regimens were found to be effective, the radiotherapy was discontinued. Only two relapses with the original treatment occurred with one death 10 years later. The modified Einhorn protocol used as primary postorchidectomy treatment has prevented relapse in all six cases in whom it was used. The overall survival rate at 2 to 10 years is 94%. There are important implications in these findings for the "watch policy" which is becoming increasingly popular. In our opinion patients should not be merely watched when histologic sectioning of the primary reveals invasion of the vessels, of whatever type, by the tumor. Instead they should be treated.