title: Surveillance for stage I testicular germ cell tumours: results and cost benefit analysis of management options.
abstract: Between 1979 and 1996 303 men with stage I testicular germ cell tumours (120 seminoma and 183 non-seminomatous germ cell tumours (NSGCT)) were enrolled onto a programme of surveillance. In our institutions the frequency of computed tomography (CT) scans is reduced compared with other centres. For all 303 men, the median follow-up is 5.1 years (range: 0.1-21.7 years) and there have only been 3 deaths (1 from disease, 1 from neutropenic sepsis and 1 from secondary leukaemia). 52/183 (28%) patients with NSGCT and 18/120 (15%) patients with seminoma have relapsed. The relapse-free survival at 5 years is 82% for seminoma and 69% for NSGCT (Logrank P=0.004). All men who relapsed, except 1 man with NSGCT, were in the International Germ Cell Cancer Collaborative Group good or intermediate prognosis group at relapse. Half of the seminoma relapses presented with symptoms and 31% of the NSGCT relapses. The remaining relapses were detected serologically or radiologically by the surveillance programme. 5 men (2%) on surveillance, 3 with initial diagnosis of seminoma and 2 with NSGCT, have developed second contralateral testis tumours (all stage I seminomas). In a well motivated centre a policy of surveillance for stage I testicular germ cell tumours (both NSGCT and seminoma) is associated with a low mortality rate (3/303, 1%) and may have the advantage of sparing overtreatment with potentially toxic therapies in this group of young men.
authors.affiliation: Department of Oncology, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.
authors.forename: R
authors.initials: R
authors.lastname: Francis
authors.forename: M
authors.initials: M
authors.lastname: Bower
authors.forename: G
authors.initials: G
authors.lastname: Brunström
authors.forename: L
authors.initials: L
authors.lastname: Holden
authors.forename: E S
authors.initials: ES
authors.lastname: Newlands
authors.forename: G J
authors.initials: GJ
authors.lastname: Rustin
authors.forename: M J
authors.initials: MJ
authors.lastname: Seckl
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D018237:Germinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D016609:Neoplasms, Second Primary / Q000188:drug therapy; D009919:Orchiectomy / Q000379:methods; D015397:Program Evaluation; D018239:Seminoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*