Adjuvant chemotherapy for stage II nonseminomatous testicular cancer: what is its role?
Two treatment options cure nearly all patients with pathological stage II testicular nonseminomatous germ cell tumor (NSGCT) following a retroperitoneal lymph node dissection (RPLND). These are (1) two cycles of adjuvant cisplatin-based chemotherapy and (2) close surveillance with chemotherapy reserved for patients who relapse. The decision to choose one of these options is dependent on the extent of tumor involvement at RPLND and patient compliance. Surveillance is the treatment of choice for compliant patients with minimal nodal involvement (<6 nodes involved, no node >2 cm, no extranodal extension; N(1), N(2a)) resected at RPLND; one third or less of these patients relapse to surveillance alone. Patients with "high volume" nodal involvement (<6 nodes involved, any node >2 cm; N(2b) or extranodal extension; N(3)) have a relapse rate of 50% to 90% to surveillance. The option of adjuvant chemotherapy in this group remains a strong consideration. A prospective trial of two cycles of etoposide plus cisplatin adjuvant chemotherapy for patients with pathological stage N(2b,3) showed that this regimen was highly effective and preferable to vinblastine-based regimens because it was better tolerated.
Motzer
R J
RJ
Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014747:Vinblastine / Q000008:administration & dosage
D001761:Bleomycin; D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin