Current concepts in the management of testicular germ cell tumours in adults. A review.

Due to a combination of aggressive chemotherapy and radical surgery today most cases of advanced non-seminomatous germ cell tumours of the testicle can be cured. The most active chemotherapeutic regimen is a combination of cis-platinum, velban, and bleomycin: the epipodophyllotoxin VP-16-213 still being a second hand alternative. Surgery is applied for definite cure in low-stage disease and for debulking of remaining tumour after initial chemotherapy in advanced stages. Survival figures today are given as 100% in stage I, 90% in stage II, and 60% in stage III. Low-stage seminoma is still routinely treated with radiotherapy, however, chemotherapy seems to markedly improve survival also in advanced stages of this disease. The use of highly toxic chemotherapy and advanced surgery necessitates a concentration of these cases to few centres with experienced staff. The article also briefly discusses classification, symptoms, diagnostic aids, and follow-up procedures.