An appraisal of the role of radiation therapy in the management of nonseminomatous germ-cell tumors of the testis in the era of effective chemotherapy.

Patients with nonseminomatous germ-cell tumors of the testis can be divided into two broad groups. The first includes patients with negative lymphograms or small-volume metastases confined to the abdominal nodes. The overall cure rate with orchiectomy and nodal irradiation is 80%. A policy of early detection of relapse and treatment with chemotherapy is advocated. Adopting this approach, no deaths have occurred in this group of patients treated in 1976 and 1977, and only one (associated with acute myeloblastic leukemia) occurred in 1975. The second group consists of patients with other stage categories who receive chemotherapy as initial treatment, followed in stage II and II and selected stage IV patients by radiation therapy to sites of initial involvement and surgery. Preliminary experience has shown this to be a practicable and promising approach. The prognosis for stage IV patients depends upon metastatic site and volume; in those patients with limited lung disease 80% are surviving disease-free.