Primary lymphadenectomy or primary chemotherapy in advanced metastatic testicular tumor?

The treatment of advanced metastasized germ cell tumor consists in a combination of chemotherapy and surgical tumor resection. The sequence of treatment measures is still not uniform. 55 patients with clinically apparent retroperitoneal metastases ('bulky disease') and/or extensive parenchymal metastases are reported. Chemotherapy was performed initially in 40 cases with subsequent resection of the retroperitoneal or parenchymal residues. Of 28 patients with the finding of necrosis/fibrosis or mature teratoma in the dissection preparation, 23 b1e alive and free of tumors. Of 14 patients with the finding of highly malignant tumor, 9 died. In 15 cases, we carried out 'surgical debulking' before chemotherapy: 5 of these patients died as a result of progression in the further course. The advantages and disadvantages of the two treatment modalities are described and discussed. Advanced stages of germ cell tumor with distant metastases should initially be treated with inductive chemotherapy and the tumor residues should subsequently be removed by delayed resection. The sequence in the case of a retroperitoneal 'bulky tumor' without distant metastases is a matter of further discussion and needs a prospective randomized study.