Survival after surgery for germinal malignancies of the testis. II. Effects of surgery and radiation therapy

We have compared the survival to 17 years after simple orchiectomy or after orchiectomy with retroperitoneal lymph node resection for germ cell tumors of the testis. The latter, more radical procedure may have had short-term value in men with embryonal carcinoma. Short-term value in other tumor groups, and long-term value in all tumor groups are questionable. In men who initially had clinical evidence of metastasis, radical surgery appears to have substantially improved survival. Only limited data on therapeutic irradiation were available, but survival was best in men whose multiportal skin exposures to radiation were between 5,000 R and 9,000 R. Deaths in the 3rd through the 17th year after surgery were grouped as due to metastases (37 cases), new primary malignancies (15 cases), irradiation effects (24 cases), or all other causes (30 cases). Deaths from metastasis tended to occur early, and accounted for over half of the mortality in years 3 to 7. Deaths from new primary malignancies are three times more common than expected. Radiation appears to diminish in importance as a cause of death while new primary malignancies become more important.