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years

Figure 12-5. The number of lung radiographs made at six centers during follow-up of patients with stage I nonseminomatous germ cell tumors. (MSKCC = Memorial Sloan-Kettering Cancer Center.)

years

Figure 12-5. The number of lung radiographs made at six centers during follow-up of patients with stage I nonseminomatous germ cell tumors. (MSKCC = Memorial Sloan-Kettering Cancer Center.)

without risk. The policy of surveillance and no biopsy of the contralateral testis will almost inevitably lead to the development of a second cancer in 5% of patients, with total castration as the only possible treatment.57 The patient will lose his endogenous androgen production, a loss that will have a serious negative impact on his quality of life, even with androgen replacement. Therefore, localized irradiation has been introduced as treatment of CIS in this group of patients.61 Initially, a dose of 20 Gy in 10 daily fractions was effectively shown to eradicate CIS and thereby prevent subsequent cancer development.62,63 However, Leydig's cell function is affected by this treatment as evidenced by a rise in luteinizing hormone (LH) level and a decline in the hCG-stimulated testosterone concentration.62,63 Therefore, the irradiation dose has subsequently been decreased to 18 Gy and 16 Gy, but there is still some effect on hormone production.64*

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