Skip to main content
SpringerLink
Log in

Treatment of clinical stage I testicular cancer and a possible role for new biological prognostic parameters

  • Review
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Three different treatment strategies for patients with stage I non-seminomatous testicular cancer are available that will all result in long-term survival in more than 98% of the patients: a “wait and see” strategy with follow-up and chemotherapy in cases of tumour progression, retroperitoneal lymphadenectomy, with or without application of systemic chemotherapy, in cases of retroperitoneal metastases (pathological stage II disease) or primary adjuvant chemotherapy following inguinal orchiectomy. Each treatment strategy is associated with specific side-effects. In several studies histological characteristics of the primary tumour, particularly the presence of vascular invasion and of embryonal carcinoma cells, have been demonstrated to be significant prognostic factors for the risk of occult retroperitoneal metastases in patients with stage I disease. In addition, new biological prognostic factors determined by flow cytometry, cytogenetic analysis or molecular-biological DNA or RNA analysis have been investigated, among which alterations of thep53 tumour-suppressor gene may represent a promising new prognostic factor. Although alterations ofp53 gene expression seem to be associated with advanced tumour stage and may predict retroperitoneal metastatic disease, the independent role of these molecular genetic alterations needs to be prospectively studied. Currently a risk-adapted treatment strategy based on the histological criteria of vascular invasion and the presence of embryonal carcinoma can be used to stratify patients into a “high-” and “low-risk” group with respect to tumour progression. While primary-nervesparing retroperitoneal lymphadenectomy or adjuvant chemotherapy with two cycles of platinum, etoposide and bleomycin may be appropriate for patients with a high risk (above 40%) for tumour progression, a “wait-and-see” strategy can be used for “low-risk” (less than 15% risk of progression) patients. Molecular investigations of prognostic factors may be able to improve further the stratification of patients into these different risk categories.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

RLA :

retroperitoneal lymphadenectomy

SCF :

stem-cell factor

References

  • Albers P, Albers J, Cummings OW, Boris M, Donohue JP, Foster RS (1995a) Flow cytometric and cytophotometric DNA analysis cannot predict subsequent tumour recurrence in pathological stage II A/B non-seminomatous testicular germ cell tumour patients who do not receive adjuvant chemotherapy. Eur J Cancer 31A: 848–849

    Google Scholar 

  • Albers P, Ulbright TM, Albers J, Miller GA, Foster RS, Donohue JP (1995b) New prognostic parameters to predict pathological stage A nonseminomatous testicular germ cell tumours (NSGCT). J Urol 153: 244 A

    Google Scholar 

  • Allhoff EP, Liedke S, Riese W de, Stief CG, Tanke HJ, Schneider B, Kramer AEJL, Jonas U (1991) Assessment of individual prognosis for patients with NSGCT/CS I. J Urol 145: 367 A

    Google Scholar 

  • Atkin NB, Baker MC (1982) Specific chromosome change, i(12p), in testicular tumours. Lancet 2: 1349

    Google Scholar 

  • Babaian RJ, Bracken RB, Johnson DE (1981) Complications of transabdominal retroperitoneal lymphadenectomy. Urology 17: 126–128

    PubMed  Google Scholar 

  • Bokemeyer C, Schmoll H-J, Kuczyk MA, Beyer J, Siegert G (1995) Risk of secondary leukemia following high cumulative doses of etoposide during chemotherapy for testicular cancer. J Natl Cancer Inst 87: 58–60

    PubMed  Google Scholar 

  • Bokemeyer C, Kuczyk MA, Dunn T, Serth J, Hartmann K, Jonasson J, Pietsch T, Jonas U, Schmoll HJ (1996) Expression of stem cell factor and its receptor c-kit protein in normal testicular tissue and malignant germ-cell tumours. J Cancer Res Clin Oncol 122: 301–306

    PubMed  Google Scholar 

  • Bosl GJ, Dimitrovsky E, Reuter VE, Samaniego F, Rodriguez E, Geller NL, Chaganti RS (1989) Isochromosome of the short arm of chromosome 12. Clinically useful marker for male germ cell tumours. J Natl Cancer Inst 81: 1874–1878

    PubMed  Google Scholar 

  • Bürger RA, Braun MH, Witzsch U, Potratz D, Stöckle M, Hohenfellner R (1993) Automated DNA-image analysis in testicular cancer; value of 5c exceeding rate as prognostic factor. J Urol 149: 390 A

    Google Scholar 

  • Chevreau C, Forni M de, Soulie M, Mihura J, Plante P (1991) Is adjuvant chemotherapy a beneficial treatment in stage I high risk nonseminomatous testicular germ cell tumours? Eur J Cancer [Suppl 2] 651 A

    Google Scholar 

  • Costello AJ, Mortensen PH, Stillwell RG (1989) Prognostic indicators for failure of surveillance management of stage I non-seminomatous germ cell tumours. Aust NZ J Surg 59: 119–122

    Google Scholar 

  • Cullen MH, Stenning SP, Parkinson MC, Fossa SD, Horwich AH, Kaye SB, Harland SJ, Williams MV, Jakes R (1995) A short course adjuvant chemotherapy in high risk stage I non-seminomatous germ cell tumours of the testis (NSGCT): an MRC (UK) study report. Proc Am Soc Clin Oncol 14: 244A

    Google Scholar 

  • De Riese WTW, Walker EB, De Riese C, Jones JA, Foster RS, Donohue JP, Messemer J (1993) Predictive value of proliferative parameters measured by flow cytometry in early stage non-seminomatous germ cell tumours (NSGCT). J Urol 149: 962A

    Google Scholar 

  • Donohue JP (1987a) Controversies in testis cancer management. In: Kernion J de, Paulson D (eds.) Genitourinary cancer management. Lea & Febiger Philadelphia pp 161–186

    Google Scholar 

  • Donohue JP (1987b) Management of low clinical stage testis cancer (editorial comment). Urol Clin North Am 14: 729–730

    Google Scholar 

  • Donohue JP (1990) Nerve-sparing retroperitoneal lymphadenectomy. Beitr Onkol 40: 124–132

    Google Scholar 

  • Donohue JP, Rowland RG (1981) Complications of retroperitoneal lymph node dissection. J Urol 125: 338–340

    PubMed  Google Scholar 

  • Donohue JP, Einhorn LH, Perez JM (1978) Improved management of nonseminomatous testis tumours. Cancer 42: 2903–2908

    PubMed  Google Scholar 

  • Donohue JP, Thornhill JA, Foster RS, Rowland RG, Bihrle R (1993a) Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965–1989): modifications of technique and impact on ejaculation. J Urol 149: 237–243

    PubMed  Google Scholar 

  • Donohue JP, Thornhill JA, Foster RS, Rowland RG, Bihrle R (1993b) Primary retroperitoneal lymph node dissection in clinical stage A non-seminomatous germ cell testis cancer: review of the Indiana University experience 1965–1989. Br J Urol 71: 326–335

    PubMed  Google Scholar 

  • Dunphy CH, Ayala AG, Swanson DA, Ro JY, Logothetis C (1988) Clinical stage I nonseminomatous and mixed germ cell tumours of the testis. Cancer 62: 1202–1206

    PubMed  Google Scholar 

  • Fernandez EB, Sesterhenn IA, McCarthy WF, Mostofi FK, Moul JW (1994) Proliferating cell nuclear antigen expression to predict occult disease in clinical stage I nonseminomatous testicular germ cell tumours. J Urol 152: 1133–1138

    PubMed  Google Scholar 

  • Fossa SD, Ous S, Abyholm T, Norman N, Loeb N (1985) Post-treatment fertility in patients with testicular cancer. II. Influence of cis-platin-based combination chemotherapy and of retroperitoneal surgery on hormone and sperm cell production. Br J Urol 57: 210–214

    PubMed  Google Scholar 

  • Fossa SD, Ous S, Stenwig AE, Lien HH, Aas N, Kaalhus O (1990) Distribution of retroperitoneal lymph node metastases in patients with non-seminomatous testicular cancer in clinical stage I. Eur Urol 17: 107–112

    PubMed  Google Scholar 

  • Fossa SD, Nesland JM, Waehre H, Amellem O, Pattersen EO (1991) DNA ploidy in the primary tumour from patients with non-seminomatous testicular germ cell tumours clinical stage I. Cancer 67: 1984

    PubMed  Google Scholar 

  • Freedman LS, Parkinson MC, Jones WG, Oliver RTD, Peckham MJ, Read G, Newlands ES, Williams CJ (1987) Histopathology in the prediction of relapse of patients with stage I testicular teratoma treated by orchiectomy alone. Lancet 2: 294–298

    PubMed  Google Scholar 

  • Fung CY, Kalish LA, Brodsky GL, Richie JP, Garnick MB (1988) Stage I nonseminomatous germ cell testicular tumour: prediction of metastatic potential by primary histopathology. J Clin Oncol 6: 1467–1473

    PubMed  Google Scholar 

  • Gibas Z, Prout GR, Sandberg AA (1984) Malignant teratoma of the testis with an isochromosome No. 12, i(12p), as the sole structural cytogenetic abnormality. J Urol 139: 762–763

    Google Scholar 

  • Gimmi C, Sonntag R, Brunner K (1990) Adjuvant treatment of high risk (HR) clinical stage I testicular carcinoma (TC) with cisplatin (C), bleomycin (B) and vinblastine (V) or etoposide (E). Proc Am Soc Clin Oncol 8: 140

    Google Scholar 

  • Gressler V, Levine L, Vogelzang N (1990) A third option in the management of patients with clinical stage 1, non-seminomatous germ cell tumour? J Clin Oncol 8: 4–8

    PubMed  Google Scholar 

  • Hoskin P, Dilly S, Easton D, Heroic A, Hendry W, Peckham MJ (1986) Prognostic factors in stage I nonseminomatous germ cell testicular tumours managed by orchiectomy and surveillance. Implications for adjuvant chemotherapy. J Clin Oncol 4: 1031–1036

    PubMed  Google Scholar 

  • Jacobson GK, Rorth M, Osterlind K, von der Maase H, Jacobson A, EL Madsen, Pedersen M, Schultz H, Danish Testicular Cancer Study Group (1990) Histopathological features in stage I nonseminomatous testicular germ cell tumours correlated to relapse. APMIS 98: 377–382

    PubMed  Google Scholar 

  • Jewett MAS, Torbey C (1988) Nerve-sparing techniques in retroperitoneal lymphadenectomy in patients with low-stage testicular cancer. Semin Urol 6: 233–237

    PubMed  Google Scholar 

  • Jewett MAS, Kong Y-SP, Golberg SD, Sturgeon JFG, Thomas GM, Alison RE, Gospodarowicz MK (1988) Retroperitoneal lymphadenectomy for testis tumour with nerve sparing for ejaculation. J Urol 139: 1220–1224

    PubMed  Google Scholar 

  • Klepp O, Olsson AM, Henrikson H, Aass N, Dahl O, Stenwig AE, Persson BE, Cavalli-Stahl E, Fossa SD, Wahlquist L (1990) Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. J Clin Oncol 8: 509–518

    PubMed  Google Scholar 

  • Kuczyk MA, Serth J, Bokemeyer C, Allhoff EP, Jonassen J, Kuczyk S, Jonas U (1994) Oveeexpression of the p53 oncoprotein in carcinoma in situ of the testis. Pathol Res Pract 190: 993–998

    PubMed  Google Scholar 

  • Kuczyk MA, Serth J, Bokemeyer C, Hervatin C, Oelke M, Oelert F, Höfner K, Jonas U (1995) Wertigkeit von Proliferationsstatus (PCNA) und p53-Immunhistochemie als Prognosefaktor für den klinischen Verlauf superfizieller Harnblasenkarzinome. Urologe A 34: 146–152

    PubMed  Google Scholar 

  • Lange PH, Change WY, Fraley EE (1987) Fertility issues in the therapy of nonseminomatous testicular tumors. Urol Clin North Am 14: 731–747

    PubMed  Google Scholar 

  • Lewis DJ, Sesterhenn IA, McCarthy WF, Moul JW (1994) Immunohistochemical expression of p53 tumor suppressor gene protein in adult germ cell testis tumors: clinical correlation in stage I disease. J Urol 152: 418–423

    PubMed  Google Scholar 

  • Madej G, Pawinski A (1991) Risk-related adjuvant chemotherapy for stage I non seminoma of the testis. Clin Oncol R Coll Radiol 3: 270–272

    PubMed  Google Scholar 

  • McLeod DG, Weiss RB, Stablein DM, Muggia FM, Paulson DF, Ellis JH, Spaulding JT, Donohue JP (1991) Staging relationships and outcome in early stage testicular cancer: A report from the Testicular Cancer Intergroup Study. J Urol 145: 1178–1183

    PubMed  Google Scholar 

  • Moul JW, Robertson JE, George SL (1989) Complications of therapy for testicular cancer. J Urol 142: 1491–1496

    PubMed  Google Scholar 

  • Moul JW, Theune SM, Chang EH (1992) Detection of RAS mutations in archival testicular germ cell tumors by polymerase chain reaction and oligonucleotide hybridization. Genes Chromosomes & Cancer 5: 109–118

    Google Scholar 

  • Moul JW, Foley JP, Hitchcock CL, Mc Carthy WF, Sesterhenn IA, Becker RL, Griffin JL (1993) Flow cytometric and quantitative histological parameters to predict occult disease in clinical stage I nonseminomatous testicular germ cell tumors. J Urol 150: 879–883

    PubMed  Google Scholar 

  • Moul JW, McCarthy WF, Fernandez EB, Sesterhenn IA (1994) Percentage of embryonal carcinoma and vascular invasion predict pathologic stage in clinical stage I nonseminomatous testicular cancer. Cancer Res 54: 1–3

    PubMed  Google Scholar 

  • Nigro JM, Baker SJ, Preisinger AC, Jessup JM, Hostetter R, Cleary K, Bigner SH, Davidson N, Baylin S, Devilee P, Glover T, Collins FS, Weston A, Modali R, Harris CC, Vogelstein B (1989) Mutations in the p53 gene occur in diverse human tumor types. Nature 342: 705–708

    PubMed  Google Scholar 

  • Oliver RTD, Raja MA, Ong J (1992) Pilot study to evaluate impact of a policy of adjuvant chemotherapy for a high risk stage I malignant teratoma on overall relapse rate of stage I patients. J Urol 148: 1453–1456

    PubMed  Google Scholar 

  • Oliver RTD, Ong J, Ostrowski J, Williams M (1993) One versus two courses of adjuvant therapy compared to radiotherapy of surveillance for stage I germ cell tumours. In: Jones WG, Harden P, Appleyard I (eds) Germ cell tumours. III. Elsevier Science, Oxford New York Tokyo, pp 203–205

    Google Scholar 

  • Peckham MJ, Barrett A, Husband JE, Hendry WF (1981) Orchiectomy alone in testicular stage I nonseminomatous germ cell tumors. Lancet 2: 678

    Google Scholar 

  • Peng HQ, Hock D, Malkin D, Bailey D, Gallie BL, Bulebul M, Jowett M, Buchanan J, Goss PE (1993) Mutations of the p53 gene do not occur in testis cancer. Cancer Res 3: 3574–3578

    Google Scholar 

  • Pietsch T, Serth J, Stanulla M, Kuczyk MA, Bokemeyer C, Thon WF, Jonas U (1994) Coexpression of stem cell factor and its receptor c-kit in germ cell tumors. J Urol 151: 408A

    Google Scholar 

  • Pizzocaro G (1985) Unilateral lymphadenctomy in preoperative clinically negative non-seminoma. In: Khoury S, Küss R, Murphy GP, Chatelain C, Karr JP (eds) Testicular Cancer. Liss, New York, pp 563

    Google Scholar 

  • Pizzocaro G (1991) Management of stage I nonseminoma: rationale for lymphadenectomy. In: Horwich A (ed) Testicular cancer, 1st edn. Chapman & Hall London New York Tokyo, pp 167–173

    Google Scholar 

  • Pizzocaro G, Monfardini S (1984) No adjuvant chemotherapy in selected patients with pathologic stage II nonseminomatous germ cell tumors of the testis. J Urol 131: 677–680

    PubMed  Google Scholar 

  • Pont J, Höltl W, Kosak D (1990) Risk-adapted treatment choice in stage I non-seminomatous testicular germ cell cancer by regarding vascular invasion in the primary tumor: a prospective trial. J Clin Oncol 8: 16–20

    PubMed  Google Scholar 

  • Read G, Stenning SP, Cullen MH, Parkinhson MC, Horwich A, Kaye SB (1992) Prospective study of surveillance for stage I testicular teratoma: MRC Testicular Tumour Working Party. J Clin Oncol 10: 1762–1768

    PubMed  Google Scholar 

  • Richie JP (1988) Modified retroperitoneal lymphadenectomy for patients with clinical stage I testicular cancer. Semin Urol 6: 216–222

    PubMed  Google Scholar 

  • Richie JP (1990) Clinical stage I testicular cancer: the role of modified retroperitoneal lymphadenectomy. J Urol 144: 1160–1163

    PubMed  Google Scholar 

  • Rodriguez E, Mathew S, Reuter V, Ilson DH, Bosl GJ, Chaganti RS (1992) Cytogenetic analysis of 124 prospectively ascertained male germ cell tumors. Cancer Res 52: 2285–2291

    PubMed  Google Scholar 

  • Rowland RG, Donohue JP (1988) Testicular cancer: innovations in diagnosis and treatment. Semin Urol 6: 223–232

    PubMed  Google Scholar 

  • Sago AL, Ball TP, Novicki DE (1979) Complications of retroperitoneal lymphadenectomy. Urology 13: 241–243

    PubMed  Google Scholar 

  • Sandemann TF, Yang C (1988) Results of adjuvant chemotherapy for low-stage nonseminomatous germ cell tumors of the testis with vascular invasion. Cancer 62: 1471–1475

    PubMed  Google Scholar 

  • Sarkis AS, Dalbagni G, Cordon-Cardo C, Zhang ZF, Sheinfeld J, Fair WR, Herr HW, Reuter VE (1993) Nuclear overexpression of p53 protein in transitional cell bladder carcinoma: a marker for disease progression. J Natl Cancer Inst 85: 53–59

    PubMed  Google Scholar 

  • Schmoll HJ, Waegener W (1984) Adjuvant therapy in resectable stage II nonseminomatous testicular cancer. In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer. IV. Grune & Stratton, Orlando, pp 539–548

    Google Scholar 

  • Serth J, Kuczyk MA, Bokemeyer C, Hervatin C, Nafe R, Tan HK, Jonas U (1995) p53 immunohistochemistry as an independent prognostic factor for transitional cell carcinoma of the bladder. Br J Cancer 71: 201–205

    PubMed  Google Scholar 

  • Sesterhenn IA, Weiss RB, Mostofi FK, Stablein DM, Rowland RG, Falkson G, Rivkind SE, Vogelzang NJ (1992) Prognosis and other clinical correlates of pathologic review in stage I and II testicular carcinoma: a report from the Testicular Cancer Intergroup Study. J Clin Oncol 10: 69–78

    PubMed  Google Scholar 

  • Skinner DG, Melamud A, Lieskovsky G (1982) Complications of thoraco-abdominal retroperitoneal lymph node dissection. J Urol 127: 1107–1110

    PubMed  Google Scholar 

  • Sogani PC, Whitmore WF, Herr HW (1984) Orchiectomy alone in the treatment of clinical stage I nonseminomatous germ cell tumor of the testis. J Clin Oncol 2: 267–270

    PubMed  Google Scholar 

  • Stauffenberg A, Brensing KA (1990) Veränderungen des Hormonhaushalts durch Chemotherapie. Beitr Onkol, 40: 115–123

    Google Scholar 

  • Stephenson RA (1991) Surveillance for clinical stage I non-seminomatous testis carcinoma: rationale and results. Urol Int 46: 290–293

    PubMed  Google Scholar 

  • Strohmeyer T, Peter S, Hartmann M, Munemitsu S, Ackermann R, Ullrich A, Slamon DJ (1991) Expression of thehst-1 and c-kit protooncogenes in human testicular germ cell tumors. Cancer Res 51: 1811–1816

    PubMed  Google Scholar 

  • Strohmeyer TG, Fleischhacker M, Imai Y, Slamon DJ, Koeffler HP (1993) Status of the p53 tumor suppressor gene and the MDM-2 gene in human testicular tumors. J Urol 149: 311A

    Google Scholar 

  • Strohmeyer T, Reese D, Press M, Ackermann R, Hartmann M, Slamon D (1995) Expression of c-kit proto-oncogene and its ligand stem cell factor (SCF) in normal and malignant human testicular tissue. J Urol 153: 511–515

    PubMed  Google Scholar 

  • Studer UE, Fey MF, Calderoni A, Kraft R, Mazzuchelli L, Sonntag RW (1993) Adjuvant chemotherapy after orchiectomy in high risk patients with clinical stage I nonseminomatous testicular cancer. Eur Urol 23: 444–449

    PubMed  Google Scholar 

  • Swanson DA, Johnson DE (1989) M. D. Anderson experience with surveillance for clinical stage I disease. In: Johnson DE, Logothetis CJ, Von Eschenbach AC (eds) Systemic therapy for genitourinary cancers. Year Book Medical Publishers, Chicago, pp 304–311

    Google Scholar 

  • Thor AD, Moore DH, Edgerton SM, Kawasaki ES, Reihsaus E, Lynch HT, Marcus JN, Schwartz L, Chen LC, Mayall BH, Smith HS (1992) Accumulation of p53 tumor suppressor gene protein: an independent marker of prognosis in breast cancers. J Natl Cancer Inst 84: 845–854

    PubMed  Google Scholar 

  • Visakorpi T, Kallioniemi OP, Heikkinen A, Koivula T, Isola J (1992) Small subgroup of aggressive, highly proliferative prostatic carcinomas defined by p53 accumulation. J Natl Cancer Inst 84: 883–887

    PubMed  Google Scholar 

  • Weißbach L, Bode HU (1982) Die modifizierte Lymphadenektomie zur Protektion der Ejakulation. Beitr Onkol 8: 133–138

    Google Scholar 

  • Weißbach L, Bussar-Maatz, R (1995) Können Risikofaktoren die Strategien im Stadium I des Nicht-Seminoms bestimmen? Akt Urol 26: 79–88

    Google Scholar 

  • Weißbach L, Sommerhoff C, Struth B (1980) Aussagen zur Fertilität bei Patienten mit germinalen Hodentumoren. Extr Urol 3: 159–174

    Google Scholar 

  • Weißbach L, Boedefeld EA for the Testicular Tumor Study Group (1987) Localization of solitary and multiple metastases in stage II nonseminomatous testis tumor as basis for a modified staging lymph node dissection in stage I. J Urol 138: 77–82

    PubMed  Google Scholar 

  • Weißbach L, Boedefeld EA, Horstmann-Dubral B (1990) Surgical treatment of metastatic stage II nonseminomatous testis tumor. J Urol 146: 1295–1298

    Google Scholar 

  • Whitmore W (1979) Surgical treatment of adult germinal testis tumor. Semin Oncol 6: 55–68

    PubMed  Google Scholar 

  • Williams SD, Stablein DM, Einhorn LH, Muggia FM, Weiss RB, Donohue JP, Paulson DF, Benner KW, Jacobs EW, Spaulding JT (1987) Immediate adjuvant chemotherapy versus observation with treatment at relapse in pathological stage II testicular cancer. N Engl J Med 317: 1433–1438

    PubMed  Google Scholar 

  • Wishnow KI, Dunphy CH, Johnson DE, Ayala AG, Swanson DA, Ro JY, Tenney DM, Eschenbach AC, Babaian RJ (1989) Identifying patients with low risk clinical stage I nonseminomatous testicular tumors who should be treated by surveillance. Urology 34: 339–343

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine II, Eberhard-Karls-University Tübingen, Otfried-Müller-Str. 10, D-72076, Tübingen, Germany

    Carsten Bokemeyer, Jörg T. Hartmann & Lothar Kanz

  2. Department of Urology, Hannover University Medical School, 30623, Hannover, Germany

    Markus A. Kuczyk, Jürgen Serth & Udo Jonas

  3. Department of Hematology and Oncology, Hannover University Medical School, D-30623, Hannover

    Hans-Joachim Schmoll

Authors
  1. Carsten Bokemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Markus A. Kuczyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jürgen Serth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jörg T. Hartmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hans-Joachim Schmoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Udo Jonas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lothar Kanz
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bokemeyer, C., Kuczyk, M.A., Serth, J. et al. Treatment of clinical stage I testicular cancer and a possible role for new biological prognostic parameters. J Cancer Res Clin Oncol 122, 575–584 (1996). https://doi.org/10.1007/BF01221188

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01221188

Key words

Search

Navigation