tumor bed and resection rim, frozen section analysis, biopsyof the peripheral parenchyma, postoperative radiation of theremaining testicle with 18 Gy., close followup and manage-ment of testicular cancer at an experienced center. In thefuture it will be surgically possible to resect even small tes-ticular tumors in the presence of a normal contralateraltestis without harming the patient. One must consider thatall patients will have testicular intraepithelial neoplasia inthe tumor bearing testicle that will proliferate if not treatedwith local radiation. However, local radiation has the poten-tial to damage the contralateral normal testis if no individ-ualized shielding is applied.

Dr. Hans Joachim Schmoll reviewed the manuscript.

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EDITORIAL COMMENT

This series on organ sparing surgery in patients with metachro-nous or synchronous bilateral testicular tumors from the GermanTesticular Cancer Study Group is important. The major benefit ofsuch an approach is that 85% of patients in the long term did notneed testosterone replacement after partial orchiectomy and irradi-ation. This effect is a reasonable approach in patients with secondtesticular primaries who do not want to be fertile. This and otherstudies have shown that if only partial orchiectomy is performed andpostoperative radiation not given the probability of a local recurrenceis relatively high. Therefore, most would recommend postoperativeirradiation, which eliminates spermatogenesis.

Because 60% of these tumors were seminomas and irradiation isrequired postoperatively to minimize local recurrence, an intriguingquestion is whether or not up front irradiation could yield similarresults, with partial orchiectomy reserved for only those cases thatdid not respond completely to irradiation. Although an interestingbiological question, it likely has little clinical relevance since theresults of the approach described in this paper appear to be good inregard to long-term outcome, minimization of local recurrence andpreservation of normal testosterone levels in 85% of cases. Therefore,we have learned from this well documented study that partial orchi-ectomy is feasible in select patients, postoperative radiotherapy isnecessary to minimize local recurrence and 85% will have normaltestosterone levels in the long term.

Richard S. FosterDepartment of UrologyIndiana University Medical CenterIndianapolis, Indiana

ORGAN SPARING SURGERY FOR TESTICULAR CANCER 2165