Risk-adapted treatment for patients with clinical stage I nonseminomatous germ cell tumor of the testis.
OBJECTIVE
To evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical Stage I nonseminomatous germ cell testicular tumor at high risk of relapse will spare patients additional chemotherapy or surgery.


METHODS
High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dL or greater, 80% embryonal cell carcinoma or greater, or vessel invasion in the primary tumor. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting of carboplatin, etoposide, and bleomycin. Low-risk patients and high-risk patients not receiving chemotherapy were observed.


RESULTS
Of 99 patients, we classified 76 as high risk and 23 as low risk of relapse. All but eight of the high-risk patients received chemotherapy. No patient who underwent chemotherapy developed relapse, although 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lymphadenectomy for mature teratoma. Two of the 23 low-risk patients had disease relapse; both successfully underwent chemotherapy. The nonhematologic toxicity was mild in patients receiving chemotherapy, and no patient required hospitalization. The median follow-up was 38 months (range 9 to 69).


CONCLUSIONS
Two courses of postorchiectomy adjuvant chemotherapy were safe and well tolerated and markedly decreased the relapse rate in high-risk patients with clinical Stage I nonseminomatous germ cell testicular tumor without additional surgery or more protracted chemotherapy. This approach may avoid potential problems with compliance and diminish the cost of scrupulous follow-up. Our results support that surveillance for carefully selected patients at a low risk of relapse is appropriate.
Amato
Robert J
RJ
Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA.
Ro
Jae Y
JY
Ayala
Alberto G
AG
Swanson
David A
DA
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D001761:Bleomycin / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D018236:Carcinoma, Embryonal / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage; D018237:Germinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009361:Neoplasm Invasiveness; D009363:Neoplasm Proteins / Q000032:analysis; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D009919:Orchiectomy; D011379:Prognosis; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D013724:Teratoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis
D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D000509:alpha-Fetoproteins; D001761:Bleomycin; D005047:Etoposide; D016190:Carboplatin