A total of 16 patients with advanced germ cell cancer underwent initial chemotherapy that was followed by a delayed orchiectomy for an unrecognized primary in 3 and for life-threatening distant metastatic cancer in 13. Of these patients 13 had a complete and 3 had a partial remission at the time of the delayed orchiectomy. Of the former 13 patients 3 (23 per cent) had persistent viable tumor in the testis. To data all 3 patients have remained free of disease for more than 12, 20 and 30 months, respectively, without further therapy. One early relapse (1 month) was found in the remaining 10 patients with a complete remission and without viable disease in the testis. Of the 3 patients with a partial remission 1 had residual tumor in the testis and disease progressed despite further therapy. There was no evidence of tumor in the testis in the other 2 patients. These data document the presence of a differential response of germ cell tumors in the primary and metastatic sites. Post-chemotherapy orchiectomy for a suspicious primary tumor of the testis is necessary because of the risk of persistent primary disease. The post-chemotherapy pathological findings in the resected primary tumor do not reflect the systemic response.
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