Primary chemotherapy after orchidectomy for stage I and II nonseminoma

The effectiveness of combination chemotherapy in advanced germ cell cancer has led to re-evaluation of treatment approaches in early disease. For patients with stage I nonseminoma it became possible to contemplate an observation policy, relying on chemotherapy to rescue those who relapsed. Subsequently it has been shown that two cycels of adjuvant chemotherapy can prevent relapse in those at high risk. For patients with stage II nonseminoma, a policy of primary chemotherapy postorchidectomy leads to high cure rates, with avoidance of retroperitoneal lymph node dissection, and only a minority of patients requiring lymphadenectomy. The excellent prognosis of these patients increases the importance of minimising risks of any long-term treatment toxicity.