Possible new approaches to the management of seminoma of the testis.

A review of 21 newly diagnosed patients with either advanced Stage 2 or Stages 3 and 4 metastatic seminoma treated with platinum based chemotherapy regimes has demonstrated 17 long-term disease-free survivors (81%) compared with 10 of 18 such patients treated by radiotherapy between 1960 and 1977 (56%) and 10 of 34 treated before 1960 (29%). These results somewhat overstate the benefit of chemotherapy over radiotherapy because the incidence of seminoma as a proportion of all germ cell tumours changed, following a change in histological and radiological staging procedures during that period. However, the data presented do suggest that seminoma may be even more sensitive to chemotherapy than malignant teratoma, since 12 of the 21 patients reported received cisplatin as a single agent and 10 of these survived. These observations have lead to a re-investigation of the relapse rate of Stage 1 seminoma in a surveillance study. To date, 10 of 11 patients observed have remained relapse-free for a median of 11 months' follow-up.