The investigation and treatment of germ cell tumours of the testis.

Fifty-five per cent of patients presenting with testicular tumours in 1973--78 had teratomata. A history of undescended testis was only found in patients with seminoma. The right testis was the more frequent site of the primary. Radiation doses of 3400 cGy (rad) in 20 fractions for seminoma and 4500 cGy in 25 fractions for teratoma were well tolerated and sterilised microscopic disease in the majority of patients. Forty-two of 44 seminoma patients are alive and free from disease at a median follow-up of three years. Only 15 of 22 Stage I teratoma patients remain disease free, however. A combination of vinblastine and bleomycin produced 12 complete remissions in 30 patients with metastatic teratoma. Survival was significantly longer for patients achieving complete remission. Although six of the complete responders remain alive, only three are in their initial complete remission. Alpha-foeto-protein and/or beta-subunit human chorionic gonadotrophin levels were elevated in almost all cases of advanced teratoma. The biological half-life of alpha-foeto-protein in the serum is less than six days. The value of these markers in predicting relapse was limited in this series. The doubling of complete response rate in metastatic teratomata that can be achieved by adding cis-platinum to the vinblastine/bleomycin combination, together with the propensity for extranodal metastasis shown by testicular teratomata, suggest that adjuvant chemotherapy should be explored in early disease.