In: NEOPLASMA, vol. 54, no. 5
D. Ondrus - M. Ondrusova - M. Hornak - J. Matoska
Detaily:
Rok, strany: 2007, 437 - 442
O článku:
Surveillance after orchiectomy alone becomes popular for the management of clinical stage I nonseminomatous germ
cell testicular tumors (CS I NSGCTT). Effort to identify patients at high risk of relapse leads to searching for risk factors of
CS I NSGCTT. The aim of the study was to analyse own long-term experiences with different therapeutic approaches in CS
I NSGCTT patients according to risk factors of the disease progression and to correlate these results with the group of
patients who were treated with surveillance strategy only. From 11/1984 to 12/1991 a total of 145 patients with CS I NSGCTT
were treated with surveillance strategy only (group A) and were followed-up to 1/2007. Patients, who had the disease
progression, were treated with systemic chemotherapy. The disease progression was experienced in 52 patients (35.9 %).
The overall survival rate of the patients in this group was 130/145 (89.7 %). From 1/1992 to 1/2007 a total of 323 patients
with CS I NSGCTT were stratified to different risk-adapted therapeutic approaches (groups B1-3) according to histopathologic
findings of primary tumor removed by inguinal orchiectomy. 111 patients (group B1) with vascular invasion and majority of
embryonal carcinoma component in the primary tumor were treated with adjuvant chemotherapy (2 cycles of BEP). Disease
progression developed in two patients (1.9 %). Other patients live without evidence of disease (NED). None of them died.
Among 11 patients (group B2) with vascular invasion and majority with teratomatous elements in the primary tumor underwent
primary retroperitoneal lymph node dissection (RPLND), 9 were found to be pathological stage I. The disease progression
was observed in two patients (18.2 %), they died 87-122 months following orchiectomy. Two patients (18.2 %) with pathological
stage II received adjuvant chemotherapy. Other 7 patients live with NED following RPLND. 201 patients (group B3) without
vascular invasion have been followed after orchiectomy alone. They were kept under close surveillance, consisting of regular
follow-up with tumor markers, chest x-ray and CT of the retroperitoneum. The disease progression was observed in 39
patients (19.4 %), who were treated with BEP chemotherapy. Three of them (7.7 %) died after a mean follow-up of 32.7
months following orchiectomy. The overall survival rate of all patients in group B1-3 was 98.4 %. Introduction of different
therapeutic approaches in CS I NSGCTT patients according to risk factors of the disease progression might reduce the
overall relapse rate of these patients from 35.9 % (group A) to 19.4 % (group B3) (P< 0.001). Surveillance procedure is
recommended only in patients without vascular invasion in the primary tumor.
Key words: testicular cancer, surveillance, adjuvant chemotherapy, lymph node dissection
Ako citovať:
ISO 690:
Ondrus, D., Ondrusova, M., Hornak, M., Matoska, J. 2007. Nonseminomatous germ cell testicular tumors – clinical stage I:
differentiated therapeutic approach in comparison with therapeutic
approach using surveillance strategy only. In NEOPLASMA, vol. 54, no.5, pp. 437-442. 0028-2685.
APA:
Ondrus, D., Ondrusova, M., Hornak, M., Matoska, J. (2007). Nonseminomatous germ cell testicular tumors – clinical stage I:
differentiated therapeutic approach in comparison with therapeutic
approach using surveillance strategy only. NEOPLASMA, 54(5), 437-442. 0028-2685.