[Therapy of non-seminomatous testicular tumor stage II A/B (pT+N1/2Mo)]

In these stages standard therapy (RLND + 2 courses PEB) reveals survival rates of more than 95%. The high rates of toxic side effects from two aggressive treatment strategies induce considerations about reducing therapy. We may be able to omit one of the therapeutic methods: (a) RLND alone can cure half of the patients; the others could have chemotherapy if progression is found. (b) Primary chemotherapy shows complete remission in 75% of the cases; only every fourth patient has to undergo surgical resection of a residual tumor. Survival rates for both strategies are no different than those following standard therapy. Further modifications concern surgical techniques (modified unilateral RLND, nerve sparing RLND) in order to preserve an antegrade ejaculation, as well as other chemotherapy regimens by omitting one of the drugs (PE instead of PEB) or replacing one by another with fewer toxic effects (CEB instead of PEB). Current clinical trials should answer the question of which of the therapeutic options impairs quality of life less.