Risk Adapted Management With Adjuvant Chemotherapy in Patients With High Risk Clinical Stage I Nonseminomatous Germ Cell Tumor

PURPOSE: We propose that patients with high risk, clinical stage I nonseminomatous germ cell tumors receive 2 cycles of chemotherapy initially, instead of undergoing surgery or observation. MATERIALS AND METHODS: A total of 59 patients with high risk, clinical stage I nonseminomatous germ cell tumor received risk adapted adjuvant chemotherapy. Until June 1987, 20 patients were treated with 2 courses of adjuvant cisplatin, vinblastine and bleomycin at 3-week intervals. After June 1987 another 39 patients were treated with 2 cycles of bleomycin, etoposide and cisplatin. RESULTS: Long-term results with this treatment strategy have been excellent with limited morbidity. CONCLUSIONS: Adjuvant chemotherapy may be of particular value in patients with compromised followup.