Treatment and surgical staging of testicular and primary extragonadal germ cell cancer.

Fifty-four patients with disseminated germ cell cancer (primary testicular, 39; primary extragonadal, 15) were treated with vinblastine sulfate, bleomycin sulfate, and cisplatin, followed by tumor-reductive surgery. Cyclophosphamide and doxorubicin hydrochloride were given after surgery. Thirty-five patients with primary testicular disease achieved a complete remission; two of these relapsed from complete remission, and one died in complete remission. Median follow-up was 37 months. Ten (67%) of the 15 patients with extragonadal cancer achieved a complete remission; five of these relapsed from complete remission, and only four remained in complete remission for a median of 40 months. Thirty-eight patients underwent surgery after chemotherapy. Eleven had residual cancer, 14 had teratoma, and 13 had fibrosis. The use of remission-induction chemotherapy followed by surgical removal of residual abnormalities can cure most patients with disseminated testicular cancer. These same therapeutic strategies are inadequate in the treatment of patients with primary extragonadal disease.