Radiation  For localized seminoma, radiation therapy to the pelvis and retroperitoneal lymph
               node areas is used as a preventive measure. Since most Stage I seminoma cases will probably never relapse, an investigational question is whether radiation (or even chemotherapy) is needed at all.

               Chemotherapy  There are many commonly used chemotherapy regimens for Stage III and, to
               some extent, for Stage II cases. Each agent has been found to be active against testis tumors when given alone, but prolonged, complete disappearance of tumors is best when other drugs are combined with cisplatin .
    The earlier regimens of PVB and VAB-6 have mostly been replaced by PEB and EP.
There is some controversy concerning the need for bleomycin , since one study reported
that the relapse rate is higher when this drug is not included in etoposide and cisplatin (or carboplatin) combinations.
    While the older combinations are still sometimes given as so-called salvage therapy in relapsing cases, the ones containing ifosfamide (IEC and VIP), a derivative of cyclophosphamide , are the new salvage therapies. Because ifosfamide is a urinary bladder irritant that can produce blood in the urine, uroprotective drugs such as mesna and NAC are required to prevent this complication. Such drugs do not affect the antitumor activity of ifosfamide.