Surveillance alone versus radiotherapy after orchiectomy for clinical stage I nonseminomatous testicular cancer. Danish Testicular Cancer Study Group.

Abstract

From December 1980 to January 1984, all patients with stage I nonseminomatous testicular cancer in Denmark entered a randomized trial comparing surveillance only with radiotherapy after orchiectomy. One hundred fifty patients were assessable for the final analysis. Relapse occurred in 23 patients in the surveillance group and in 11 patients in the radiotherapy group. Radiotherapy completely prevented retroperitoneal relapse; 14 retroperitoneal relapses occurred in the surveillance-only group. All relapsing patients in the surveillance-only group are without evidence of disease with a median observation time after chemotherapy of 67 months. Two of the patients with relapse in the radiotherapy group died with disease; the others are alive without evidence of disease, with a median observation time after relapse treatment of 72 months. In the surveillance group, four relapses occurred later than 2 years after orchiectomy; only one such late relapse occurred in the radiotherapy group. Four of the retroperitoneal relapses occurred without concomitant increase in the serum marker levels (alpha-fetoprotein [AFP] and human chorionic gonadotropin [HCG]). It is concluded that surveillance only should replace radiotherapy after orchiectomy as standard treatment for clinical stage I nonseminomatous testicular cancer. Improved methods for control of retroperitoneal relapses, especially of embryonal carcinomas, are needed.

Importance of a new tumor market TRA-1-60 in the follow-up of patients with clinical stage I nonseminomatous testicular germ cell tumors

“…Discordance in the behavior of AFP and hCG has been described by other investigators (5,(34)(35)(36) and has also been reviewed (37). This discordance presumably reflects irradication of the marker-producing portion of the tumor cell population with survival and recurrence of another portion (38).…”

Germ cell tumours of the testis

“…Long-term follow-up is important, since relapses have also been observed later than 5 years post-orchidectomy in patients followed by surveillance programme [107][108][109]. Close cooperation between the patient and physician is imperative if a surveillance option is used.…”

Canadian consensus guidelines for the management of testicular germ cell cancer

“…The survival outcomes are summarized in Table 5. 13,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The presence of microscopic vascular or lymphatic invasion in the primary tumour is the most important factor predicting relapse and the presence or absence of this factor has been used to divide patients: those with high-risk disease (a third of the cases) who have about a 50% risk of relapse, and those with low-risk disease who have about a 15% to 20% risk of relapse. 45 …”