Alternatives to radiotherapy in the management of seminoma.
In a period from January 1978 to January 1989, 114 patients with seminoma have been managed, primarily in studies aimed at examining alternatives to radiotherapy. In a pilot study of single agent platinum in 27 previously untreated patients with metastatic seminoma, 82% remain progression-free and 89% alive and disease-free at 5 years compared with 81% progression-free and 88% alive and disease-free in a selected group of 16 previously untreated patients who received platinum-based combination treatment. Results from a pilot study of surveillance in 26 patients with stage 1 seminoma showed that 27% developed evidence of further disease (5 relapses, 2 second tumours) by 3 years, with all relapse patients salvaged by subsequent treatment. Because of the slow pace of relapse compared with malignant teratoma, with relapses occurring after 2 years, a pilot study was initiated to evaluate the effect of 2 courses of adjuvant carboplatin. The results to date in 25 patients suggest that with the use of modern antiemetics this regimen is as well tolerated as prophylactic radiotherapy. With a median follow-up of 16 months there has been 1 relapse subsequently salvaged by combination chemotherapy. A radomised trial is now justified to assess the quality of life and late toxicity of this approach compared with prophylactic radiotherapy.
Department of Medical Oncology, London Hospital Medical College.
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Oliver
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Lore
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D016190:Carboplatin; D002945:Cisplatin / Q000008:administration & dosage / Q000627:therapeutic use*; D004407:Dysgerminoma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D014747:Vinblastine / Q000008:administration & dosage
D009944:Organoplatinum Compounds; D001761:Bleomycin; D014747:Vinblastine; D016190:Carboplatin; D002945:Cisplatin