Germ cell testicular tumors in clinical stage A and normal values of serum tumor mark-ers post-orchiectomy: the experience in the management of 300 consecutive patients.
OBJECTIVE
To report the outcome and survival of patients with clinical stage A (CS-A) testicular seminoma (TS) treated with adjuvant carboplatin (CBDCA), and the value of primary nerve-sparing retroperitoneal lymphadenectomy (RPLA), adjuvant cisplatin and surveillance in the risk-adapted management of CS-A patients with nonseminomatous testicular tumors (NSTT) and normal values of serum tumor markers post-orchiectomy.


METHODS
From August 1985 to June 2003, 300 patients with CS-A germ cell testicular tumors (GCTT) entered a prospective non-randomized study. 163 patients with TS received post-orchiectomy 2 cycles of adjuvant CBDCA (400 mg/m(2) q 3 wks). 137 patients with NSTT were divided into two groups according to risk-adapted management: arm A (n=33)- RPLA in 23 high-risk patients (pre-orchiectomy AFP > 80 ng/ml, > 80% embryonal carcinoma, microvascular tumor invasion/VI+), and in 10 low-risk patients; and arm B (n=104)-65 high-risk patients received 2 cycles of cisplatin-based chemotherapy, whereas 39 patients with low risk were put under surveillance.


RESULTS
After a median follow-up of 4 years (range 1-9) all patients with TS were alive and disease-free (ADF). Relapses occurred in 3 (1.9%) patients treated with CBDCA, with complete response (CR) following cisplatin-based chemotherapy. Arm A relapses following RPLA in high-risk pathological stage (PS)- A occurred in 3 out of 18 (17%) patients, with CR following chemotherapy in 2 of them, while 5 patients with retroperitoneal lymph node (RPLN) metastasis had universal survival, resulting in 22 (95.6%) patients being ADF after a median follow-up of 9 years (range 8-10.2). Among 10 low-risk patients, 2 (20%) had RPLN metastasis and received cisplatin-based chemotherapy without disease relapse. All 10 patients are ADF after a median follow-up of 8.8 years (range 6.7-10.4). In arm B one of 65 high-risk patients (1.5%) treated with cisplatin-based chemotherapy relapsed in the lung at 9 months. Sixty-four (98.5%) patients are ADF after a median follow-up of 4 years (range 1.2-6.5). Six of 39 patients (15.4%) on surveillance relapsed and achieved CR with subsequent chemotherapy alone. All of them are ADF after a median follow-up of 5.5 years (range 1-10.2).


CONCLUSIONS
Adjuvant CBDCA chemotherapy is an acceptable approach in CS-A TS, whereas 2 cycles of cisplatin-based chemotherapy compare well with the results taken with RPLA in high-risk CS-A NSTT. Surveillance is an appropriate strategy in strictly selected patients with low-risk CS-A NSTT and normal post-orchiectomy values of serum tumor markers.
Argirović
Dj
Dj
Clinic of Urology, Division of Urologic Chemotherapy, Clinical Center of Serbia, Beograd, Serbia and Montenegro.