Initial chemotherapy for stage II testicular non-seminoma

Abstract

A retrospective survival analysis was performed on 287 patients treated with chemotherapy following orchidectomy for stage II testicular non-seminoma between 1982 and 1986 at a number of centres in the United Kingdom and 1 centre in Norway. A total of 80 patients had lymphadenectomy for a residual mass after chemotherapy. In 17 of these cases the histology was undifferentiated malignancy, in 44 it was differentiated teratoma, in 18 there was necrosis only and in 1 case histology was unknown. The overall survival in 47 patients with initial stage IIA disease (nodes measuring < 2 cm in transverse diameter) was 98% [95% confidence interval (CI), 96%-100%] at 3 years. In 175 patients with stage IIB disease (nodal diameter, 2-5 cm) the 3-year survival was 96% (95% CI, 93%-99%) and in 65 patients with stage IIC disease (nodal diameter, > 5 cm) it was 84% (95% CI, 75%-93%). In stage IIA and stage IIB disease this approach leads to survival equivalent to that obtained with the approach of initial retroperitoneal lymph-node dissection.

Follow-Up Management of Patients With Testicular Cancer: A Multidisciplinary Consensus-Based Approach

“…Approximately 75% of patients with clinical stage IIA NSGCT will achieve complete response with primary chemotherapy. 40,45 The European Germ Cell Cancer Consensus Group (EGCCCG), 46 Indiana University, 47 and ESMO 24 guidelines do not recommend RPLND for patients who achieve remission with a residual mass less than 1 cm. The authors recommend surveillance.…”

Canadian consensus guidelines for the management of testicular germ cell cancer

“…Patients with a rapidly growing lesion and/or a concomitant increase of the tumour, markers should not be resected but treated with primary BEP chemotherapy according to the treatment algorithm for patients with metastatic disease and IGCCCG recommendations. [90][91][92] When RPLND is performed this should be done using a full template nerve-sparing technique. 69 Further options after RPLND are surveillance or adjuvant chemotherapy.…”

Impact of Surgical Resection of Metastases Refractory to Systemic Therapy on Survival and Quality of Life – a Phase II Trial

“…However, surgery as single therapy is doomed to fail once hematogenic tumor spread has already occurred resulting in a systemic progression rate of 50% [3]. With the introduction of effective systemic chemotherapy for testicular cancer, the second condition for a successful treatment has been realized so that almost all patients with early metastasis and low tumor burden can be cured [4]. Because of the superior results of systemic chemotherapy we have now completely abandoned primary retroperitoneal lymph node dissection and perform metastatic surgery only for residual tumor subsequent to che- Rübben/Bex/Lümmen/Krege/Baschek/Otto patients (67/85) could be discharged and henceforward treated on an outpatient basis.…”