The role of radiation therapy in the treatment of germinal cell tumors of the testis other than pure seminoma.

Between March 1944 and September 1976, 279 patients with nonseminomatous testicular tumors were treated. The 3-year NED rates for patients with Stages I, IIA, and IIB were 78.2%, 46.7%, and 17.6%, respectively. However, the results were better for patients treated with preoperative radiotherapy and lymphadenectomy with or without postoperative radiotherapy (Stage IIA: 77.5%--14/18; Stage IIB: 12.9%--3/7). Postoperative radiotherapy is not necessary for patients with negative nodes at lymphadenectomy because the periaortic failure rate is low for this group. However, when positive nodes are found, the control is improved with radiotherapy. The minimum tumor dose required when tumor is found but resected is not known. When there is gross residual tumor, a dose of 4,500-5,500 rad is required to achieve any salvage. In this series, 42.2% of patients with positive nodes at lymphadenectomy (Stages I and II) developed extranodal metastases. This group might benefit from adjunctive chemotherapy.