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Background: Oncologic treatment of childhood testicular germ cell tumors can be regarded as a model of curable neoplasm. Over 50% of the tumors are stage I A, produce alpha-fetoprotein and thus provide after semicastration a "wait and see" policy., Patients: The MAHO 82, 88, 94 cooperative studies registered between 1982 and 1997 197 patients, 110 patients had yolk sac tumors (YST), 47 differentiated teratomas (TD), 38 malignant teratomas of either intermediate (MTI), undifferentiated (MTU), or trophoblastic type (MTT) and two seminomas. After semicastration only 65 patients received standard chemotherapy according to stage and histology consisting of four courses of vinblastine, bleomycin and cisplatin. If after two courses viable tumor was indicated, delayed laparotomy was performed (seven patients). Patients with incomplete tumor response after two courses received three courses of etoposide, ifosfamide and cisplatin (nine patients)., Results: 105 patients had YST stage I, five higher stages of disease. One of these died by tumor progression. Of 91 patients followed according to "wait and see" only 14 needed standard chemotherapy. The NED of 105 patients is 99%. 47 patients had TD stage I; the NED is 100%. 13 patients had malignant teratomas stage I. 13 patients had stage II and received chemotherapy; the NED for these 26 patients is 100%. 12 patients had stages III or IV, four died., Conclusion: In testicular germ cell tumors of childhood in alpha-fetoprotein producing tumors of stage I A a "wait and see" program is safe. X-irradiation or primary lymphadenectomy can be omitted since chemotherapy alone reveals excellent results.

Objective: Human chorionic gonadotropin (HCG) elevations in the testicular vein (TV) are correlated with those in the cubital vein (CV). Their significance was tested regarding various prognostic parameters., Method: Within the framework of a large multicentre study to assess the prognosis of HCG-positive seminomas 726 eligible patients were recruited from 1986 to 1991. A total of 378 had elevated and 348 had normal HCG measured in the CV. In 144 patients samples were taken from the TV. Histological diagnosis of seminoma was confirmed by two reference pathologists. Three groups (group I: elevated HCG in CV and normal or elevated HCG in TV; group II: normal HCG in CV and elevated HCG in TV; group III: normal HCG in CV and normal or unknown HCG in TV) were compared in relation to the presence or absence of metastases, stage of the disease, size of the primary tumour, pT category, vascular invasion and lactate dehydrogenase., Results: Of the TV serum samples, 85% were HCG-positive. Regression analysis revealed higher values in the TV compared to the CV according to the following equation: HCGTV = 520 + 1.12 x HCGCV, R = 0.766, with a mean variation of 14%. Patients in group I had significantly higher stages and larger primary tumours than patients with normal HCG in the CV, irrespective of the HCG values in the TV blood (groups II and III). Therefore, HCG is associated with tumour mass. No differences of statistical significance were found regarding T category, vascular invasion and lactate dehydrogenase. There were no differences between groups II and III., Conclusion: Only HCG values of the CV are associated with known adverse-prognostic factors of seminomas, such as metastases and size of the tumour. HCG in the TV adds no further information for the clinical assessment of patients with seminoma.