Role of adjuvant chemotherapy in patients with stage II nonseminomatous germ-cell tumors.

Two options exist in the management of pathologic stage II nonseminomatous germ-cell tumors after retroperitoneal lymphadenectomy. First, patients may be followed closely and given three or four cycles of cisplatin-based chemotherapy at relapse. This option is appropriate only if compliance with follow-up is ensured. Second, patients with pathologic stage N2b or N3 disease may be given two cycles of cisplatin-based adjuvant chemotherapy. This approach nearly guarantees a cure but subjects patients who are not destined to have a relapse to chemotherapy. Such management is mandatory in patients who are noncompliant.