Introduction and Objectives
Testis cancer is the most common cancer in young men and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. We aimed to evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical stage I, nonseminomatous germ cell testicular tumour at high risk of relapse, will spare patients additional chemotherapy or surgery.
Material and Methods
High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dL, 80% embryonal cell carcinoma or greater, vessel invasion in the primary tumour and tumour stage pT2 or greater. Low risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting cisplatinum, etoposide, and bleomycin (BEP). Lowrisk patients were observed.
Of the 108 patients, we classified 71 as high risk and 37 as low risk of relapse. All of the high-risk patients received two courses of BEP chemotherapy. Low risk-patients were kept on close-up. The median follow-up was 26 months (range 10 to 60). 3 of the 71 patients in high-risk group relapsed with viable cancer and required additional chemotherapy and 1 patient with normal biomarkers and a late-appering mass underwent retroperitoneal lympadenectomy for mature teratoma. All 4 relapsed patients were in high risk group and presently they are free of disease. None of the 37 patients at low risk of recurrences developed relapse.
We recommend two courses of adjuvant chemotherapy after postorchiectomy for high-risk patients with stage I nonseminomatous germ cell tumour of the testis. Adjuvant chemotherapy for these patients results in a low relapse and morbidity, wich compares favorably with the results of surveillance or RPLND. This well-tolerated approach may spare patients additional surgery or protracted chemotherapy, reduce the cost, and eliminate the compliance problems associated with intensive follow-up of high-risk patients.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.