RPLND or primary chemotherapy in clinical stage IIA/B nonseminomatous germ cell tumour s?
Historically, RPLND has been used for both staging and therapeutic purposes, with patients with PS II disease often being given adjuvant chemotherapy.
Two non-randomized studies of adjuvant RPLND in the management of stage I NSGCT were identified in a recent systematic review of the literature.
75] Because the RCT compared adjuvant chemotherapy to RPLND, only the chemotherapy arm was included in the meta-analysis.
Some experts involved in the development of these recommendations suggested that RPLND may be a useful option for patients at high risk of relapse.
For patients who prefer immediate treatment or who are unsuitable for primary surveillance, adjuvant chemotherapy with 2 cycles of BEP is recommended, although RPLND remains an option.
Three treatment options have been used in the past: primary RPLND alone, primary RPLND with adjuvant chemotherapy and primary chemotherapy followed by residual tumour resection.
If the lesion grows slowly and without corresponding increase of the tumour markers, RPLND should be performed by an experienced surgeon because of suspected teratoma.
When RPLND is performed this should be done using a full template nerve-sparing technique.