As the pathological changes important in the development of testicular malignancies become increasingly understood, controversy over the management of the premalignant stage carcinomain situhas heightened. Although totally effective in the short term, the role of radiotherapy to the contralateral testis has been questioned because of its effect on sexual potency and testicular endocrine function. In cytogenetic studies the isochrome i(12p) is emerging as a marker chromosome and recent reports on DNA ploidy are helping our understanding of the steps in tumour pathogenesis. Eighty per cent of patients with metastatic germ-cell tumours are cured by combination chemotherapy but new information has highlighted the benefits of surgery in marker-positive disease. High-dose chemotherapy with autologous bone marrow transplantation also appears important in a small group of patients with drug-resistant disease. In the treatment of stage 1 non-seminoma, adjuvant chemotherapy has emerged as a viable alternative to surgery or surveillance, although surveillance in stage 1 seminoma also appears safe. Long-term follow up of patients with germ-cell tumours shows an excess of non-testicular malignancies in the radiotherapy group. An important priority for the next decade will be to exclude these as a late effect of adjuvant chemotherapy in stage 1 disease.
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