Abstract
Nonseminomatous germ cell tumor is an extraordinary tumor in terms of demonstrating the impact of regional lymphadenectomy on survival. Over the years many series have shown that node-positive (pathologic stage II) patients can be cured with local measures in excess of 50% of cases. There are a variety of anatomical considerations that make testicular lymphatic drainage predictable. These relate to features of anatomic descent of the gonad and its associated lymphatics. A number of topographic studies have supported the regional deposition of metastatic disease, and we have a good understanding of this. More importantly, there are biologic considerations that probably lend to the opportunity for cure of testis cancer patients with surgery alone. Many patients will have teratomatous elements which have somewhat lower metastatic potential. What is fascinating, however, is that even undifferentiated germ cell tumors, such as embryonal cancer, are often cured with lymphadenectomy alone. Data recently presented in a multiinstitutional cooperative study show that a control group treated with node dissection alone had more than half of the patients as long-term survivors without relapse [1].
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Williams SD et al. (1987) Immediate adjuvant chemotherapy versus observation with treatment of relapse in pathological stage II testicular cancer. N Engl J Med 317:1433–1438
Donohue JP et al. (1988) Preservation of ejaculation following nerve-sparing retroperitoneal lymphadenectomy. J Urol 139:206A (abstr no 176)
Loehrer PJ, Williams SD, Clark SA et al. (1986) Teratoma following chemotherapy for nonseminomatous germ cell tumor (NSGCT): a clinicopathologic correlation. J Urol 135:1183
Einhorn LH, Williams SD, Mandelbaum I, Donohue JP (1981) Surgical resection in disseminated testicular cancer following chemotherapeutic cytoreduetion. Cancer 48:904–908
Einhorn LH, Donohue JP (1977) Cis-diammine-dichloroplatinum, Vinblastine and Bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 87:293–298
Donohue JP, Einhorn LH, Williams SD (1980) Cytoreductive surgery for metastatic testis cancer: considerations of timing and extent. J Urol 123:876–880
Donohue JP, Rowland RG (1984) The role of surgery in advanced testicular cancer. Cancer 54:2716–2721
Loehrer PJ, Sledge GW, Einhorn LH (1985) Heterogeneity among germ cell tumors of the testis. Semin Oncol 12:304–316
Ulbright TM, Loehrer PJ, Roth LM et al. (1984) The development of non-germ cell malignancies within germ cell tumors: a clinicopathologic study of 11 cases. Cancer 54:1824–1833
Donohue JP, Zachary JM, Maynard BR (1982) Distribution of nodal metastases in nonseminomatous testis cancer. J Urol 128:315–320
Donohue JP, Rowland RG, Bihrle R (1988) Transabdominal retroperitoneal lymph node dissection. In: Skinner DG, Leiskovsky G (eds) Diagnosis and management of genitourinary cancer. Saunders, Philadelphia, pp 802–816
Donohue JP, Rowland RG (1981) Complications of Retroperitoneal Lymphadenectomy. J Urol 125:338
Donohue JP, Foster RS, Rowland RG et al. (1991) Nerve-sparing retroperitoneal lymphadenectomy. J Urol (Submitted)
Lange PH, Chang WY, Fraley EE (1987) Fertility issues in the therapy of nonseminomatous testicular tumors. Urol Clin North Am 14:731–745
Bihrle R, Donohue JP, Foster RS (1988) Complications of retroperitoneal lymph node dissection. Urol Clin North Am 15:237–242
Hoskins P, Dilly S, Easton D (1986) Prognostic factors in stage I nonseminomatous germ, cell testicular tumors managed by orchiectomy and surveillance: implications for adjuvant chemotherapy. J Clin Oncol 4:1031–1036
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1993 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Donohue, J.P. (1993). Treatment of Local Regional Disease. In: Ackermann, R., Diehl, V. (eds) Malignancies of the Genitourinary Tract. Recent Results in Cancer Research, vol 126. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-84583-3_20
Download citation
DOI: https://doi.org/10.1007/978-3-642-84583-3_20
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-84585-7
Online ISBN: 978-3-642-84583-3
eBook Packages: Springer Book Archive