[Surveillance following orchiectomy for stage I testicular tumor]

Thirty-one cases with clinical Stage I testicular tumor were treated by surveillance policy after orchiectomy alone at Cancer Institute Hospital from April in 1985 to October in 1991. Histological types were seminoma in 22 cases and nonseminomatous germ cell tumors (NSGCT) in 9. Relapses were observed in 7 (22.5%) patients between 2.5 and 9.3 months after orchiectomy. Five (22.7%) of 22 seminoma and 2 (22.4%) of 9 NSGCT recurred and received further cis-platin based chemotherapy. In all of 5 seminoma and one of NSGCT cases recurrences developed in the retroperitoneal lymph nodes and in another NSGCT case lung metastasis was observed. All patients have been treated with success and are alive without evidence of disease between 5 and 48 months after salvage therapy. One of the recurrent cases with seminoma had an evident retroperitoneal metastasis misdiagnosed as the small intestine at staging retrospectively. And 2 of 3 seminoma cases and one of 2 NSGCT cases with minimally abnormal findings in the retroperitoneal lymph nodes had recurred. Surveillance policy may not be adequate for patients with these changes. But overall survival rate of stage I testicular tumors were estimated 100%. And relapse were observed in a small number of stage I without "minimally changes". So we regarded that surveillance policy was valid in patients with clinical stage I testicular tumor under careful staging and intensive follow up.