The human genome project has revolutionized technology for the study of
DNA. Several of this year's papers have applied these techniques to the study of
testicular cancer, especially the use of double-fluorescence in situ hybridization to identify the
germ cell tumor marker isochrome 12p in tissue sections, and loss-of-heterozygosity studies to demonstrate a candidate suppressor gene on the long arm of the same chromosome that may be a
ligand for the c-kit protooncogene. The report of a solitary case of a patient with a
tumor (in a solitary testis) who was treated by partial
orchiectomy and then fathered two children emphasizes the need for more information on fertility of patients with
carcinoma in situ before the highly effective low-dose radiation to the testis can be accepted. The confirmation of the occurrence of
acute myeloid leukemia as a late effect of
etoposide and
stomach cancer as a late effect of
radiotherapy for stage I
seminoma has drawn attention to the need to reduce treatment in good-risk patients. Results of trials substituting
cisplatin with
carboplatin and a trial eliminating
bleomycin are particularly disappointing, and the 10% lower cures with the experimental regimen in these studies is an object lesson of the risks involved in such studies. Two other issues that continue to be debated include the increasing recognition of the value of
lactate dehydrogenase-1 for identifying poor-risk patients, and the benefits of referral to a unit specializing in
testicular cancer. There is an increasing trend to use high-dose
chemotherapy for previously untreated patients who have poor risk factors. who have poor risk factors.