Topic Paper

World Journal of Urology

, Volume 27, Issue 4, pp 455-461

First online:

High-risk clinical stage I nonseminomatous germ cell tumors: the case for chemotherapy

  • Dirk H. WestermannAffiliated withDepartment of Urology, Staedtisches Klinikum Karlsruhe
  • , Urs E. StuderAffiliated withDepartment of Urology, University Hospital of Bern Email author 

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Testis cancer is the most frequent solid malignancy in young men. The majority of patients present with clinical stage I disease and about 50% of them are nonseminomatous germ cell tumors. In this initial stage of disease there is a subgroup of patients at high risk with a likelihood of more than 50% for relapse. Treatment options for these patients include: retroperitoneal lymph node dissection (RPLND), albeit 6–10% of patients will relapse outside the field of RPLND, active surveillance with even higher relapse rates and adjuvant chemotherapy. As most of these patients have the chance to become long-term survivors, avoidance of long-term side effects is of utmost importance. This review provides information on the potential of chemotherapy to achieve a higher chance of cure for patients with high-risk clinical stage I disease than its therapeutic alternatives and addresses toxicity and dose dependency.


Nonseminomatous Germ cell Chemotherapy High risk Testicular neoplasm