Table 1 Treatment strategies
From: Late recurrences of germ cell malignancies: a population-based experience over three decades
Period | Stadium I and II (small volume) a | Stadium II (high-volume) b , III and IV | |
|---|---|---|---|
Seminoma | 1971–1997 | Infradiaphragmal radiotherapy | Chemotherapy |
Alkylating agents<1980 | |||
Cisplatin-based>1980 | |||
Followed by | |||
Radiotherapy or surgery<1988 | |||
Non-seminoma | 1980–1989 | Primary RPLND (retroperitoneal lymph node dissection) (unilateral template)+Cisplatin-based chemotherapy in case of metastases | Induction chemotherapy, followed by surgical removal of residual masses: bilateral template RPLND<1985, unilateral RPLND, if possible>1985 |
(borders for unilateral template: aortic midline, ipsilateral ureter, renal vein, bifurcation of the ipsilateral iliac artery) | (borders for bilateral RPLND: ureters, the renal veins and the ipsilateral iliac bifurcation) | ||
1990–1997 | Stage I: low riskc: wait and see, high riskd: adjuvant chemotherapy | Stage II (all)–IV chemotherapy, followed by surgical removal of all residual masses, even in case of ‘normal’ abdominal CT, by nerve-sparing RPLND, if possible | |
EGGCT | 1980–1997 | Cisplatin-based chemotherapy, followed by surgical removal of residual masses, exceptionally radiotherapy only in a single small seminomatous mass | |
