title: One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group.
abstract: BACKGROUND
  SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results.
  
  
  METHODS
  In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study.
  
  
  RESULTS
  At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%.
  
  
  CONCLUSIONS
  The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.
authors.affiliation: The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway. Electronic address: torgrim.tandstad@stolav.no.
authors.forename: T
authors.initials: T
authors.lastname: Tandstad
authors.affiliation: Department of Oncology, Skane University Hospital, Lund.
authors.forename: O
authors.initials: O
authors.lastname: Ståhl
authors.affiliation: Department of Urology, Skåne University Hospital, Malmö, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Håkansson
authors.affiliation: Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen; Haukeland University Hospital, Bergen.
authors.forename: O
authors.initials: O
authors.lastname: Dahl
authors.affiliation: Institute of Clinical Medicine, University of Tromsø, Tromsø; University Hospital of North Norway, Tromsø.
authors.forename: H S
authors.initials: HS
authors.lastname: Haugnes
authors.affiliation: Department of Oncology, Ålesund Hospital, Ålesund.
authors.forename: O H
authors.initials: OH
authors.lastname: Klepp
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: C W
authors.initials: CW
authors.lastname: Langberg
authors.affiliation: Department of Oncology, Uppsala University Hospital, Uppsala.
authors.forename: A
authors.initials: A
authors.lastname: Laurell
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Oldenburg
authors.affiliation: The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Solberg
authors.affiliation: The Cancer Clinic, Norrland University Hospital, Umeå.
authors.forename: K
authors.initials: K
authors.lastname: Söderström
authors.affiliation: Department of Oncology, Skane University Hospital, Lund.
authors.forename: E
authors.initials: E
authors.lastname: Cavallin-Ståhl
authors.affiliation: Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Stierner
authors.affiliation: Department of Urology, Oslo University Hospital, Oslo, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Wahlquist
authors.affiliation: Institute of Clinical and Experimental Medicine, University of Linköping, Linköping.
authors.forename: N
authors.initials: N
authors.lastname: Wall
authors.affiliation: Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Cohn-Cedermark
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001761:Bleomycin / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage*; D005047:Etoposide / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D009367:Neoplasm Staging; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin
keywords: adjuvant chemotherapy; nonseminoma; testicular cancer