Stage I nonseminomatous germ cell tumors of the testis: radiologic follow-up after orchidectomy.

One hundred and forty-seven patients with clinical stage I nonseminomatous germ cell tumors of the testis were entered into a follow-up program after orchidectomy. Follow-up consisted of regular clinical examinations, estimations of the serum markers beta human chorionic gonadotropin and alpha-fetoprotein, chest radiography, follow-up lymphangiography, and computed tomography (CT) of the chest and abdomen. The criteria for the diagnosis of recurrence of disease were (a) a single abnormal node with elevated serum markers or positive cytologic aspirate, (b) a single enlarging node on serial studies in the absence of elevated markers, (c) multiple abnormal nodes, or (d) persistently elevated serum markers without abnormal radiologic findings. Thirty-seven patients experienced recurrence, 32 (86%) within the 1st year. Disease recurred most often in the abdomen alone (38%). CT scanning (76%) and marker estimations (68%) enabled detection of recurrent disease more often than chest radiography (22%) or lymphangiographic follow-up (13%). A strategy for follow-up based on these results is outlined.