In long-term survivors of testicular cancer, we observed a two-fold or greater risk of developing cardiovascular disease. This was not due to increases in cardiac risk factors, which suggests a direct or indirect treatment effect. These data support the continued research into the minimization of treatment in good-prognosis testicular cancer.

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in the 298 allocated to CEB (log-rank x 2 = 2 6 .9 ; P < .001), which led to failure-free rates at 1 y e a r of 91% (95% confidence interval [Cl], 88% to 94%) and 77% (95% Cl, 72% to 82%), respectively. There w ere 10 deaths in patients allocated to BEP and 2 7 in patients allocated to CEB (log-rank x* = 8.77; P = .0 0 3 ), which led to 3-year survival rates of 97% (95% Cl, 95% to 99%) and 90% (95% Cl, 86% to 94% ), respectively.Conclusion: With these drug doses and schedules, combination chemotherapy based on carboplatin was inferior to that based on cisplatin. This BEP regimen that contains moderate doses of etoposide and bleomycin is effective in the treatment of patients with good-prognosis metastatic nonseminoma.

Summary An analysis of the primary tumour histopathology was performed on 103 patients managed by orchidectomy and surveillance for stage I seminoma. Patients have been followed for 14-141 months (median 62 months) after orchidectomy. Seventeen patients relapsed, the probability of remaining relapse free at 5 years being 82% (95% confidence intervals, 74%-88%). No patients died of progressive germ cell tumours. The only significant histological factor predicting relapse was the presence of lymphatic and vascular invasion. Four of 42 patients with neither lymphatic or vascular invasion recurred, nine of 53 patients with either lymphatic or vascular invasion recurred and three of eight cases with both lymphatic and vascular invasion recurred (P = 0.05-trend). Though initial recurrence was usually of moderate volume and confined to para-aortic nodes, eight patients were treated with chemotherapy either because of the extent of their initial relapse (four cases), or because of subsequent relapse (four cases). In view of the difficulties of identifying patients at risk and of detecting early relapse, surveillance for stage I seminoma should remain a research protocol.The conventional management of stage I seminoma of the testis is by adjuvant retroperitoneal node irradiation. This policy is highly successful, recurrence occuring in less than 5% of patients (Hamilton et al., 1986;Zagars, 1991). Surveillance following orchidectomy was introduced as an alternative with the rationale that a substantial proportion of patients with stage I seminoma would not need further treatment and could thus avoid the side-effects of radiotherapy. This supposition was based partly on a series of retroperitoneal lymph node dissection in stage I seminoma, which revealed microscopic nodal involvement in only 8% of patients (Maier et al., 1968), and partly on the success of a surveillance policy in stage I non-seminomatous tumours of the testis (Freedman et al., 1987;Horwich & Peckham, 1988;Cullen, 1991). Preliminary results of surveillance for stage I seminomas have been reported (Thomas et al., 1989;Duchesne et al., 1990) and it has become apparent that the policy presents some clinical difficulties, such as for example, the relatively indolent natural history of seminoma leading to a requirement for prolonged surveillance. A second problem is the lack of a sensitive serum marker for seminoma (in contrast to non-seminoma) making it difficult to monitor patients sufficiently closely to detect small volume relapse.In (median 36 years). They have been followed for a median of 5 years and 2 months from orchidectomy (range 14 months to 141 months).Initial staging investigations prior to registering the patient for surveillance always included thorough physical examination, assay of serum concentrations of the beta sub-unit of human chorionic gonadotrophin (HCG) and alpha-fetoprotein (AFP), CT scan of thorax abdomen and pelvis, lymphogram and chest X-ray. The histopathology had always been reviewed in the Department of Histopathology of The Ro...