Current recommendations

RPLND as primary therapy is potentially curative. In addition, it defines the pathologic stage and directs management of patients who have clinical stage I or stage IIA disease and negative markers. Nodal involvement is categorized as low-volume (pN1) or high-volume (pN2) nodal disease.

The recommended treatment for patients who do not have nodal involvement (pN0) is observation alone. In patients who have pN1 disease who are compliant observation is acceptable, whereas in patients who are not compliant adjuvant therapy with two cycles of EP or BEP is suggested. Patients who have pN2 disease have a 50% to 90% risk for relapse, so adjuvant therapy with two cycles of EP or BEP is strongly favored. The preference at MSKCC for two cycles of adjuvant EP is based on tolerability of the treatment programs and the near assurance of relapse-free survival in a group of patients who otherwise have a greater than 50% chance of relapse. In the rare instance that a resected mass from RPLND is found to be greater than 5 cm (pN3) or disease is unresectable, then four cycles of EP or three cycles of BEP are warranted.

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