Introduction and Objectives
The optimal treatment regimen for patients with NSGCT stage I with stable increase of alfa-fetoprotein (AFP) and beta-chorionic gonadotropin (b-CHG) after unilateral orchiectomy has not been finally developed.
Material and Methods
From 1998 through 2008 we have followed up 219 patients with NSGCT stage I. In 42 patients (19.2%) after unilateral orchiectomy the markers increased: in 5 patients only AFP increased, in 32 – b-CHG increased, and in 5 patients both markers rose. The length of follow up comprised 6–126 months (median 36 months). In all patients after unilateral orchiectomy the retroperitoneal lymph node dissection had been performed (RPLND).
In 10 out of 32 patients with increased level of b-CHG the retroperitoneal lymph nodes were affected with metastases. In eight patients (25%) the disease progressed in 3–60 months after RPLND. Only in 1 out of 5 patients with increased level of AFP the lymph nodes were affected with metastases. The disease recurred in all 5 patients in 2–12 months after RPLND. Among 5 patients in whom both markers were elevated one patient had been diagnosed with metastasis of embryonic cancer. The disease recurred in 4 patients in 2–14 months after RPLND. In 14 patients among 17 in whom the disease recurred are in complete clinical remission after the course of adjuvant chemotherapy (ChT) during 24–60 months, one patient survives with metastases, and two patients died.
We conclude that stable elevation of each or both tumor markers after unilateral orchiectomy in patients with NSGCT stage I is associated with presence of hidden metastases. The treatment of choice in these patients is ChT till tumor markers get normal.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.