title: Chemotherapy intensification in patients with advanced seminoma and adverse prognostic factors.
abstract: OBJECTIVE
  The aim of our study was to identify factors which influence survival in patients with disseminated seminoma in the good prognostic group according to IGCCCG, as well as to evaluate the impact of treatment intensification in patients with negative prognostic factors.
  
  
  METHODS
  We analyzed the database of the patients with metastatic seminoma who had received treatment at our department from 1986 to 2005. Inclusion criteria were as follows: morphologically verified seminoma; favorable prognosis according to IGCCCG; modern chemotherapy regimen (EP ± bleomycin); AFP level <15 IU/ml; and HCG level <300 mIU/ml. The primary endpoint was overall survival (OS).
  
  
  RESULTS
  With median follow-up 83 months, 5-year OS rate was 91% in 206 patients. Only three negative prognostic factors were associated with OS: retroperitoneal lymph nodes >5 cm (p < 0.01), pulmonary metastases (p < 0.01) and LDH level ≥ 2.25 × ULN (p = 0.01). In view of the obtained data, we have changed our treatment approach since 2005. In case of any negative prognostic factors, we administered an intensified CT regimen--4BEP or 3BEP + 1EP. Prospective phase of the study included 34 patients with unfavorable prognosis. We observed an increase of 5-year OS rate in the intensified CT group in comparison with the standard CT group in patients with unfavorable prognostic from 85 to 100%.
  
  
  CONCLUSIONS
  Administration of 4 cycles of induction CT (4BEP or 3BEP + 1EP) in patients with metastatic seminoma who have LDH level ≥ 2.25 ULN, and/or retroperitoneal lymph nodes >5 cm and/or pulmonary metastases results in decreased disease progression rate and significant gain in OS.
authors.affiliation: Department of Clinical Pharmacology and Chemotherapy, N. N. Blokhin Russian Cancer Research Center, 24 Kashirskoye Shosse, Moscow, 115478, Russia, fedianinmu@mail.ru.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Fedyanin
authors.forename: Alexey
authors.initials: A
authors.lastname: Tryakin
authors.forename: Anatoly
authors.initials: A
authors.lastname: Bulanov
authors.forename: Anna
authors.initials: A
authors.lastname: Vybarava
authors.forename: Alexandra
authors.initials: A
authors.lastname: Tjulandina
authors.forename: Dzhennet
authors.initials: D
authors.lastname: Chekini
authors.forename: Olga
authors.initials: O
authors.lastname: Sekhina
authors.forename: Konstantin
authors.initials: K
authors.lastname: Figurin
authors.forename: August
authors.initials: A
authors.lastname: Garin
authors.forename: Sergei
authors.initials: S
authors.lastname: Tjulandin
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D002945:Cisplatin / Q000627:therapeutic use; D018450:Disease Progression; D005047:Etoposide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D011379:Prognosis; D016879:Salvage Therapy; D018239:Seminoma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology
chemical_list: D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin