Results of retroperitoneal lymph node dissection and postoperative adjuvant chemotherapy with dactinomycin in the treatment of retroperitoneal metastases of nonseminomatous testicular germ cell tumors.
This article discusses 103 patients with a nonseminomatous testicular germ cell tumor. Treatment of 87 patients in clinical Stages I, II-A, and II-B consisted of bilateral retroperitoneal lymph node dissection. In Stage I (54 patients), no further treatment was given. The three-year survival was 96%, while recurrence-free survival was 98%. Of 33 patients in Stages II-A and II-B, 26 received adjuvant chemotherapy with dactinomycin, and ten of these were given radiotherapy (peritoneum/mediastinum) as well. The three-year survival was 88% and recurrence-free survival was 85%. Seven patients in Stages II-A and II-B received no adjuvant chemotherapy; four of them died. Treatment of 14 patients in Stage II-C primarily consisted of dactinomycin therapy, subsequently combined with surgery and radiotherapy. The three-year survival was 28.5%. These findings raise the question whether adjuvant single-agent chemotherapy with dactinomycin for patients with a nonseminomatous testicular germ cell tumor should not be re-evaluated.
D000293:Adolescent; D000328:Adult; D003609:Dactinomycin / Q000627:therapeutic use*; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000628:therapy*; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*
D003609:Dactinomycin