Long-term follow-up of Anglian Germ Cell Cancer Group surveillance versus patients with Stage 1 nonseminoma treated with adjuvant chemotherapy
| Autor: | P Harper, V Nagund, M.J Ostrowski, David E. Neal, J. Levay, A Robinson, R Ravi, B Sizer, R. T. D. Oliver, M.V. Williams, J. Ong, Jonathan Shamash |
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| Rok vydání: | 2002 |
| Předmět: |
Oncology
Male medicine.medical_specialty Urology medicine.medical_treatment Bleomycin Drug Costs Cohort Studies chemistry.chemical_compound Retroperitoneal lymph node dissection Testicular Neoplasms Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Adjuvant therapy Humans Neoplasm Metastasis Bone Marrow Diseases Etoposide Testicular cancer Retrospective Studies Salvage Therapy Chemotherapy business.industry Cancer Health Care Costs medicine.disease Combined Modality Therapy Survival Analysis United Kingdom Surgery Regimen Treatment Outcome chemistry Chemotherapy Adjuvant Lymph Node Excision Germinoma Neoplasm Recurrence Local Nervous System Diseases business medicine.drug Follow-Up Studies |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 1527-9995 |
| Popis: | Objectives To study survival and late events after adjuvant chemotherapy in Stage 1 nonseminoma. Methods From 1978 to 1986, all patients had surveillance. From 1986, adjuvant chemotherapy (initially a 3-day regimen of etoposide, bleomycin, and cisplatin, but, more recently, bleomycin, Oncovin, and cisplatin) was offered to patients at a high risk of relapse (greater than 30%). Results A total of 382 patients with Stage 1 nonseminoma treated between 1978 and 2000 were reviewed. Of the 234 patients treated by surveillance, 71 (30%) had relapses (5 after 2 years), 6 died (2.6%) of germ cell cancer, and 3 developed second primary testicular cancer. Of the 148 men treated with adjuvant chemotherapy, 6 (4%) had relapses and 2 (1.4%) died of chemoresistant cancer. After one course of etoposide, bleomycin, and cisplatin, 3 (6.5%) of 46 developed a relapse; after two courses, 1 (3.6%) of 28 did so; and after bleomycin, Oncovin, and cisplatin every 10 days ×2, 2 (2.7%) of 74 patients did so. Of the high-risk patients who were offered adjuvant treatment, 24% declined. As a consequence, the relapse rate of the surveillance patients only fell from 36% to 27% after the introduction of adjuvant therapy, although for the total cohort treated in the adjuvant era, the relapse rate was 16%. Conclusions Adjuvant chemotherapy is more effective than retroperitoneal lymph node dissection for reducing the relapse risk in high-risk Stage 1 nonseminoma. However, given the uncertainty about the incidence of postchemotherapy late events, surveillance and retroperitoneal lymph node dissection remain justified alternatives. With positron emission tomography and laparoscopy showing increasing promise in these cases, quality-of-life studies and greater patient involvement in treatment selection are needed. |
| Databáze: | OpenAIRE |
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