OBJECTIVE: To find out up-to-date indications to adjuvant therapy in low-stage germ cell tumors (GCT) of the testis. METHODS: The authors reviewed the material of the National Cancer Institute in Milan and the major international papers on adjuvant therapies of GCT of the testis. RESULTS: Moderate dose irradiation of retroperitoneal nodes remains the standard therapy of stage I seminoma; mediastinal irradiation has been abandoned in stage II seminoma. Nerve-sparing retroperitoneal lymph node dissection and surveillance remain standard therapies for nonseminomatous stage I tumors; 2 adjuvant courses of cisplatin-based chemotherapy are under investigation in high-risk patients. Postoperative adjuvant chemotherapy is mandatory only in bulky pathological stage II non-seminoma, but it is advisable also in patients who cannot be carefully followed. CONCLUSION: The cure rates of GCT of the testis can approach 100% in low stages and similar results can be achieved with different treatment modalities, but the maximum results can be obtained in specialized centers only.
OBJECTIVE: To find out up-to-date indications to adjuvant therapy in low-stage germ cell tumors (GCT) of the testis. METHODS: The authors reviewed the material of the National Cancer Institute in Milan and the major international papers on adjuvant therapies of GCT of the testis. RESULTS: Moderate dose irradiation of retroperitoneal nodes remains the standard therapy of stage I seminoma; mediastinal irradiation has been abandoned in stage II seminoma. Nerve-sparing retroperitoneal lymph node dissection and surveillance remain standard therapies for nonseminomatous stage I tumors; 2 adjuvant courses of cisplatin-based chemotherapy are under investigation in high-risk patients. Postoperative adjuvant chemotherapy is mandatory only in bulky pathological stage II non-seminoma, but it is advisable also in patients who cannot be carefully followed. CONCLUSION: The cure rates of GCT of the testis can approach 100% in low stages and similar results can be achieved with different treatment modalities, but the maximum results can be obtained in specialized centers only.