Management of Stage II Nonseminomatous Germ-Cell Cancer

With implementation of cisplatin-based chemotherapy and improvements in surgical techniques and supportive care, the cure rate for patients with stage II nonseminomatous germ-cell cancer now exceeds 95%. For the last decade, the focus in managing patients with good-risk nonseminoma has been to minimize therapy-related toxicities while maintaining the impressive cure rate. Although patients with nodal disease >5 cm clearly require primary chemotherapy followed by resection of residual mass, patients at clinical stage IIA or IIB (adenopathy <2 cm or 2 cm–5 cm, respectively) present more of a dilemma, with some experts advocating primary surgical resection and others advocating primary chemotherapy.

Investigators from a New York City academic c…