Adjuvant chemotherapy for stage II nonseminomatous germ-cell tumors

Management options for patients with stage II nonseminomatous germ-cell tumors (NSGCT), completely resected at retroperitoneal lymph node dissection (RPLND), include 2 cycles of adjuvant cisplatin-based chemotherapy, or close surveillance, with chemotherapy reserved for patients who relapse. Both options are associated with cure in an equally high percentage of patients. The decision to choose one of these options over the other is influenced by the extent of the tumor resected and patient compliance. Surveillance is a strong consideration for patients with low-volume nodal disease at RPLND (pN1), because the relapse proportion is 30% or less. In contrast, patients with high-volume nodal involvement at RPLND (pN2) have a relapse rate of 50% to 90% with surveillance alone. Adjuvant chemotherapy is the preferable option in the latter group. A prospective trial of 2 cycles of etoposide plus cisplatin adjuvant chemotherapy for patients with pN2 tumors showed that this regimen was highly effective in achieving relapse-free survival.