Orchiectomy alone in clinical stage I nonseminomatous XXXX : a critical appraisal.

@entity1 @entity5 @entity900 @entity189 @entity160 @entity3
Sixty-two consecutive @entity1 with clinical stage I nonseminomatous @entity5 were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of @entity3 developed in 18 @entity1 (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing @entity1 was 6 months. Retroperitoneal metastases developed in ten @entity1 ; seven @entity1 had pulmonary metastases, and one @entity1 had progressive elevation of the serum @entity160 level. Relapses were significantly more frequent in @entity1 with either @entity189 , infiltrating @entity5 (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One @entity1 with relapse refused salvage therapy and died. The remaining 17 @entity1 have been rendered disease free with @entity900 combination chemotherapy and/or surgery. However, two @entity1 showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous @entity5 , but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.
