Rethinking nonseminomatous testicular cancer in U.S. Air Force pilots: case presentation and literature review.

摘要

A U.S. Air Force F-15 pilot presented with a painless testicular mass. Nonseminomatous germ cell tumor (NSGCT) of the testis was diagnosed at orchiectomy. Retroperitoneal lymph node dissection (RPLND) yielded pathology stage IIa disease when 2 of 21 abdominal lymph nodes were positive. The patient immediately underwent adjuvant chemotherapy consisting of etoposide and cisplatin. Follow-up tumor markers, abdominal and chest CT scans were negative. Randomized, prospective studies have shown excellent response rates to low volume metastatic disease. This pilot's risk of sudden incapacitation due to this tumor following orchiectomy, RPLND, and immediate adjuvant chemotherapy is below the 1% threshold set forth by the U.S. Air Force for unrestricted flying waiver. Chemotherapy for testicular cancer carries significant morbidity risks that may complicate a pilot's return to status and these are reviewed. The overall recovery from chemotherapy is poorly quantified and needs to be further evaluated to optimize a pilot's return to flying status.