Pilot Study to Evaluate Impact of a Policy of Adjuvant Chemotherapy for High Risk Stage 1 Malignant Teratoma on Overall Relapse Rate of Stage 1 Cancer Patients

Oliver, R. T. D.; Raja, M. A.; Ong, J.; Gallagher, Chris

doi:10.1016/s0022-5347(17)36937-9

Cited by 91 publications

(17 citation statements)

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“…After two cycles of cisplatin, vinblastin and bleomycin or BEP, 2 patients relapsed within a median follow-up of 93 months. Likewise, Oliver et al reported a relapse rate 4.5% (1 of 22 patients) following two cycles of adjuvant BEP in those with high risk factors [43] (Table 3). In our trial, the results are similar and in correlation with those other studies and we found that adjuvant chemotherapy is safe and decrease the relapse rate in high-risk patients.…”

Section: Discussionmentioning

confidence: 88%

“…All of the 71 patients classified as having a high risk of relapse, underwent two cycles of BEP chemotherapy. (bleomycin 30 mg on days 1, 8 and 15, Table 1 Risk criteria for adjuvant therapy in high risk patients Blood vessel ınvasion [8,43,48] Lymph vessel ınvasion [8,43,48] Embryonal cell Carcinoma [8,32,[41][42][43]48] No yolk sac tumor [8,43,48] Vascular invasion [32,38,42] Vascular invasion or local invasion of adjacent structures [46] AFP (greater than 80 ng/dl) [32] pT greater than 1 [41] etoposide 100 mg/m2 on days 1-5 and cisplatin 20 mg/m2 on days [1][2][3][4][5]. Chemotherapy was initiated between 4 and 8 weeks after orchiectomy.…”

Section: Methodsmentioning

confidence: 99%

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Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis

Güney

Sönmez

et al. 2008

Med Oncol

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Testis cancer is the most common cancer in young men and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. We aimed to evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical stage I, non-seminomatous germ cell testicular tumour at high risk of relapse, will spare patients additional chemotherapy or surgery. High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dl, 80% embryonal cell carcinoma or greater, vessel invasion in the primary tumour and tumour stage pT2 or greater. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting cisplatin, etoposide and bleomycin (BEP). Low-risk patients were observed. Of the 108 patients, we classified 71 as high risk and 37 as low risk of relapse. All of the high-risk patients received two courses of BEP chemotherapy. Low-risk patients were kept on close-up. The median follow-up was 26 months (range 10-60). Of the 71 patients in high-risk group, 3 relapsed with viable cancer and required additional chemotherapy and 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lympadenectomy for mature teratoma. All 4 relapsed patients were in high-risk group and presently they are free of disease. None of the 37 patients at low risk of recurrences developed relapse. We recommend two courses of adjuvant chemotherapy after postorchiectomy for high-risk patients with stage I non-seminomatous germ cell tumour of the testis. Adjuvant chemotherapy for these patients results in a low relapse and morbidity, wich compares favourably with the results of surveillance or RPLND. This well-tolerated approach may spare patients additional surgery or protracted chemotherapy, reduce the cost and eliminate the compliance problems associated with intensive follow up of high-risk patients.

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Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis

Güney

Sönmez

et al. 2008

Med Oncol

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“…Long-term follow up extending 10 years has confirmed the low relapse rates associated with adjuvant chemotherapy. (Chevreau et al, 2004;Westermann et al, 2008) Similarly low recurrence rates have been reported in other series also using 2 courses of BEP, (Cullen et al, 1996;Oliver, Raja, Ong, & Gallagher, 1992) allowing clinicians to draw the conclusion that there is little doubt on the efficacy of chemotherapy in preventing recurrence and achieving cure rates similar to surveillance or RPLND strategies for CS I NSGCT patients.…”

Section: Clinical Outcomes Of Adjuvant Chemotherapymentioning

confidence: 71%

Management of Non-Seminomatous Germ Cell Tumor of the Testis

Johnston¹,

Beck²

2012

Germ Cell Tumor

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“…Los protocolos de vigilancia tiene una tasa de recurrencia de 30%; en el 35% de los casos los marcadores tumorales son normales y aproximadamente el 60% de estas recurrencias ocurre en el retroperitoneo [12][13][14] . En los esquemas de quimioterapia primaria o ayudante, la recurrencia baja al 2,7%, pero existe el problema de los efectos deletéreos a largo plazo (más de 20 años) como son la aparición de cánceres secundarios y la probabilidad alta de enfermedad cardiovascular y síndrome metabólico [15][16][17][18] . Una de las críticas más importantes ha sido la utilización de una disección limitada, dado que las metástasis linfáticas retroperitoneales del cáncer testicular siguen un patrón definido, según el lado del tumor primario [19][20][21] .…”

Section: Discussionunclassified

Linfadenectomía retroperitoneal lumboaórtica laparoscópica por vía extraperitoneal en cáncer testicular no seminoma

C¹

2013

Rev Chil Cir

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Extraperitoneal laparoscopic retroperitoneal lymph node dissection in non-seminomatous testicular cancerObjective: The aim is to describe the technique of extraperitoneal laparoscopic access for retroperitoneal lymph node dissection in a series of patients with testis cancer stage A. Material and Methods: The extraperitoneal approach was performed in 5 patients with stage A testicular cancer. The technique includes the creation of a totally extraperitoneal space, full exposition of the retroperitoneum and classic retroperitoneal lymph node dissection. We analyzed demographic data, histology, access and surgical complications, estimated blood loss and follow up. Results: The average age was 29.4 years old (22-41). The mean operative time was 144 minutes, with an estimated blood loss of 42.4 ml. There were no surgical complications. The average hospital stay was 33.6 hr, and mean number of lymph nodes was 27.4 (24 -32). In long-term follow up there was no recurrence. Discussion: The extraperitoneal approach is an alternative access for retroperitoneal lymph node dissection in testis cancer patients. It allows avoiding potential intestinal lesions and there is no contraindication in patients with prior abdominal surgery.Key words: Retroperitoneal lymph node dissection, testis cancer, laparoscopy, extraperitoneal. ResumenObjetivo: Mostrar la experiencia en la técnica de disección lumboaórtica por vía totalmente extraperitoneal, en un grupo de pacientes con cáncer testicular en estadio A. Material y Métodos: La serie está formada por 5 pacientes, portadores de un tumor testicular no seminoma, en estadio A. En ellos se planteó como alternativa la linfadenectomía retroperitoneal lumboaórtica laparoscópica. La técnica quirúrgica consistió en la formación de un espacio extraperitoneal, con rechazo de peritoneo, exposición del retroperitoneo y disección linfática clásica. Se analizaron los datos demográficos, histología, complicaciones del acceso y la

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Pilot Study to Evaluate Impact of a Policy of Adjuvant Chemotherapy for High Risk Stage 1 Malignant Teratoma on Overall Relapse Rate of Stage 1 Cancer Patients

Cited by 91 publications

References 9 publications

Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis

Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis

Management of Non-Seminomatous Germ Cell Tumor of the Testis

Linfadenectomía retroperitoneal lumboaórtica laparoscópica por vía extraperitoneal en cáncer testicular no seminoma

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