Adjuvant chemotherapy for testicular teratoma with Bleomycin and Vinblastine.

Introduction Adjuvant chemotherapy is now being employed in the management of several solid tumour malignancies in an attempt to improve prognosis. It is based on the concept that chemotherapy has the greatest chance of eliminating the disease when the tumour cell mass is minimal, and therefore, it is argued that if chemotherapy be employed at a stage when metastases are likely to be present, but as yet have not become apparent (micro-metastases), they may be eliminated completely in a proportion of cases. Many centres report work based on this hypothesis, notably Bonnadonna et al and Fischer with breast cancers, and currently trials are in progress with other solid neoplasms such as bone tumours with encouraging results. We are endeavouring to extend this work to Stage I and Stage II Testicular Teratoma and we publish a preliminary report on nine such cases. Testicular teratoma is a disease mainly of males in their third and fourth decades, and not surprisingly is one of the commoner maligancies seen in service personnel, especially during years of conscription. Some of the larger series in this disease have come from military sources both in the United States and Great Britain. The British Army experience has been extensively reviewed in the past, notably, by Stephen' on clinical aspects and Field 2 on pathology. The chemosensitivity of these tumours has been shown by the high remission rates achieved in many centres in the treatment of disseminated disease, the most recent being a rate of 80% of complete remission using vinblastine, Bleomycin and Cisplatin reported by Einhorn • Encouraged by the results of Samuels\ we selected an adjuvant regime of Bleomycin and vinblastine, but one patient received vincristine alone. The prognosis of these neoplasms depends upon the extent of the disease at presentation, histological type, and time between presentation and treatment (Field).