Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy.
BACKGROUND
With treatment leading to nearly uniform cure in clinical stage I nonseminomatous testicular cancer (CSI-NSGCT), diminishing treatment-related morbidity has become the primary concern. This study examined feasibility and outcome of active surveillance as treatment in an unselected CSI patient population.


METHODS
All patients with CSI-NSGCT referred from 1998 to 2007 to the British Columbia Cancer Agency and the Oregon Testis Cancer Program were retrospectively reviewed. A total of 233 patients were identified, of which 223 chose active surveillance.


RESULTS
Vascular invasion (VI) was absent, present and unknown in 66%, 27% and 7% of cases, respectively. Overall, 49% of patients had embryonal predominant disease. Fifty-nine patients (26%) relapsed, all but one with good prognosis disease. VI was present in 30 relapsed patients. Most patients relapsed within 2 years (88%). Only 7 of 223 patients (3%) relapsed beyond 2 years. All relapses were in long-term remission following chemotherapy with or without retroperitoneal lymph node dissection (RPLND). Only 17 of 223 patients (8%) required postorchiectomy surgery. Disease-specific survival is 100% after a median follow-up of 52 months (3-136). No patient has required second-line chemotherapy.


CONCLUSIONS
Active surveillance for all CSI-NSGCT patients is associated with excellent outcomes comparable with the best results reported with primary RPLND or adjuvant chemotherapy. Nearly 75% of patients are spared any therapy after orchiectomy.
Kollmannsberger
C
C
Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada.
Moore
C
C
Department of Medicine, Earle A. Chiles Research Institute, Providence Cancer Center.
Chi
K N
KN
Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada.
Murray
N
N
Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada.
Daneshmand
S
S
Section of Urologic Oncology, Division of Urology and Renal Transplantation, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Gleave
M
M
Department of Urological Sciences, University of British Columbia, The Prostate Center at Vancouver General Hospital, Vancouver, British Columbia, Canada.
Hayes-Lattin
B
B
Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA.
Nichols
C R
CR
Department of Medicine, Earle A. Chiles Research Institute, Providence Cancer Center. Electronic address: craig.nichols@providence.org.
D000293:Adolescent; D000328:Adult; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D009919:Orchiectomy / Q000009:adverse effects / Q000534:rehabilitation* / Q000706:statistics & numerical data; D011159:Population Surveillance / Q000379:methods*; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult