[Therapeutic indications for germinal testicular tumors]

The therapeutic indications for germ cell tumours of the testis depend on the histology (pure seminoma: 45%, non-seminomatous germ cell tumour: 55%), the extension and the severity of the prognosis. The well standardised approach to pure seminomas is less clear for non-seminomatous germ cell tumours. Stage I, IIAB pure seminomas (95 to 98% of cases) should be irradiated. The dose and target volume are adapted to prophylactic (I) and curative (II) objectives. Rare seminomas with a large tumour bulk should be treated with chemotherapy. Survival is close to 100%. Stage I non-seminomatous germ cell tumour offers several theoretical possibilities. Radiotherapy is not very popular and chemotherapy appears to be to aggressive, lumboaortic lymph node dissection is being replaced by new imaging modalities and simple follow-up requires a rigorous and disciplined approach. At the Val-de-Grâce hospital (France) since 1987, we perform simple orchidectomy in favourable stage I disease: 80% are cured with no other treatment, 20% relapse and are cured by chemotherapy, in the unfavourable stage I cancers (histology, markers) or with uncertain follow-up, limited chemotherapy is performed (3 cycles of EP). Stage II and more advanced non-seminomatous germ cell tumours are divided into moderate forms (IIA, B, III, IVL1) and major forms (IIC, IVL2, L3, H+, CNS+). In the exclusive infradiaphragmatic involvement of moderate forms, some authors propose bilateral lumboaortic lymph node dissection which is invasive surgery with an efficacy declining from 90% (IIA) to 50% (IIB). The majority of teams, particularly Val-de-Grâce, administer 3 or 4 courses of BEP followed by assessment (CT scan - markers) and salvage surgery.(ABSTRACT TRUNCATED AT 250 WORDS)