Residual radiologic abnormalities are common at the completion of chemotherapy. Many abnormalities gradually regress over a period of months. Some clinicians advocate empiric radiation of residual persistent abnormalities or attempts to resect residual masses 3 centimeters or more in size. Either approach is controversial. Nevertheless, other reports indicate that size of the residual mass does not correlate well with active residual disease, most residual masses do not grow, and frequent marker and CT scan evaluation is a viable option even when the residual mass is 3 centimeters or more.
Evidence favors the omission of prophylactic radiation therapy to the mediastinum and neck.
Treatment of bilateral iliac lymph nodes may also not be necessary. There is controversy over whether any residual masses present at the completion of chemotherapy should be empirically irradiated, or whether masses greater than 3 centimeters should be resected. If preservation of fertility is an important consideration, surgical techniques for sparing sympathetic ganglia and chains without compromising the total removal of all involved nodes are available, although this technique may not be feasible in many patients. This technique is associated with postoperative preservation of ejaculation in a large number of patients. However, if the diagnosis has been made by biopsy of a metastatic site and chemotherapy has been initiated, subsequent orchiectomy is generally performed, due to the fact that chemotherapy may not eradicate the primary cancer.