title: Multicentre risk-adapted management for stage I non-seminomatous germ cell tumours.
abstract: BACKGROUND
  The Spanish Germ Cell Group is composed of 60 centres. Our challenge was to define a surveillance protocol that would be safe and suitable regardless of population size or geographic coverage.
  
  
  METHODS
  From January 1994 to January 2004, 589 patients with stage I non-seminomatous germ cell tumours entered a risk-adapted surveillance protocol after orchiectomy. Patients with vascular or local invasion of adjacent structures (231/589; 39%) received two cycles of BE400P (bleomycin 30 U/week, etoposide 100 mg/m2 x4, cisplatinum 25 mg/m2 x4). Other patients (358/589; 61%) were kept on close follow-up (chest X-ray; serum tumour markers: first year every 2 months, second year every 3 months, third year every 4 months; abdominal computed tomography scans at every other outpatient control). The outcomes selected for the study were feasibility, relapse rate and number of patients lost to follow-up and mortality.
  
  
  RESULTS
  Median follow-up was 40 months. In the surveillance group, 21 patients were lost to follow-up. In the chemotherapy group, two patients relapsed at 12 and 14.5 months and they are presently free of disease. In the surveillance group, 71 (19%) patients relapsed, of which 55 (71%) relapsed within the first year. Five (1.4%) patients died of their cancer. Factors associated with relapse were embryonal carcinoma and vascular invasion in patients who refused chemotherapy.
  
  
  CONCLUSIONS
  Our risk-adapted surveillance protocol provided a low rate of recurrences.
authors.affiliation: The Spanish Germinal Group, Spain. jmaroto@hsp.santpau.es
authors.forename: P
authors.initials: P
authors.lastname: Maroto
authors.forename: X
authors.initials: X
authors.lastname: García del Muro
authors.forename: J
authors.initials: J
authors.lastname: Aparicio
authors.forename: L
authors.initials: L
authors.lastname: Paz-Ares
authors.forename: J A
authors.initials: JA
authors.lastname: Arranz
authors.forename: J
authors.initials: J
authors.lastname: Guma
authors.forename: J
authors.initials: J
authors.lastname: Terrassa
authors.forename: J
authors.initials: J
authors.lastname: Barnadas
authors.forename: J
authors.initials: J
authors.lastname: Dorta
authors.forename: J R
authors.initials: JR
authors.lastname: Germà-Lluch
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D001761:Bleomycin / Q000008:administration & dosage; D018236:Carcinoma, Embryonal / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002822:Choriocarcinoma / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local; D009919:Orchiectomy; D011379:Prognosis; D012308:Risk Management; D018239:Seminoma / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D015996:Survival Rate; D013724:Teratoma / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor; D001761:Bleomycin; D005047:Etoposide