Management of clinical stage I testicular germ cell tumours

Testicular germ-cell cancer is the most frequent malignancy in young men. In 80% of case no metastasis is observed at diagnosis. Orchidectomy is the initial therapeutic intervention. In case of a pure seminoma, three treatment options should be discussed after surgery : radiotherapy with a limited dose and volume, surveillance, and chemotherapy by single-agent carboplatin. In non-seminomatous germ cell tumour three options should also be considered : surveillance, chemotherapy (two cycles of the BEP regimen) or retroperitoneal lymph node dissection. The strategy should be chosen taking into account predictive factors of relapse and the patient willing. Whatever the strategy, the cure rate is about 99%.