[Testicular cancer--is there an indication for adjuvant or neoadjuvant systemic therapy?]

Testicular cancer represents between 1 and 1.5% of male neoplasms and 5% of all urological tumours. There are indications for adjuvant or neoadjuvant systemic therapy in all stages of seminomatous and non-seminomatous testicular cancer. The treatment decision is strongly stage dependent. The primary treatment of choice for advanced disease is chemotherapy. In earlier stages a risk-adapted treatment should be used and besides chemotherapy, surveillance, radiotherapy and sometimes retroperitoneal lymph node dissection can be considered. In early stages it is important to reduce immediate adjuvant treatment in as many patients as possible to avoid acute and late toxicities. In advanced stages randomized trials have to clarify if there could be a better outcome with adding new agents or with high-dose chemotherapy for patients with "poor prognosis" and adverse features or patients with a chemoresistant relapse.