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- Title
Optimizing the adjuvant therapy in stage I nonseminomatous germ cell tumors.
- Authors
Singh, Bhupendra P.; Choubey, Vimal K.; Pandey, Rahul
- Abstract
With an aim to offer minimized risk-adapted adjuvant treatment to clinical stage 1 nonseminomatous germ-cell testicular cancer patients, this study recruited 745 subjects into a prospective, community-based multicenter Swedish and Norwegian Testicular Cancer Project (SWENOTECA) management program over the period from 1998 to 2005. Treatment strategy depended on the presence or absence of vascular tumor invasion. Vascular invasion positive patients were recommended brief adjuvant chemotherapy with bleomycin, etoposide, and cisplatin (BEP), whereas vascular invasion negative patients could choose between ACT and surveillance. Results showed overall 51 relapses at a median follow-up of 4.7 years. In the surveillance group, relapse rate was 41.7% in patients with vascular invasion and 13.7% in patients without vascular invasion. In adjuvant chemotherapy (one course of BEP) group relapse rate was 3.2% in patients with vascular invasion and 1.3% in patients without vascular invasion. Authors concluded that one course of adjuvant BEP reduced the risk of relapse by approximately 90% in all (with or without vascular invasion) CS1 NSGCT and this may be a new option as initial treatment for all CS1 NSGCT. One course of adjuvant BEP for vascular invasion positive CS1 reduces the total burden of chemotherapy compared with surveillance or two courses of BEP. SWENOTECA currently recommends one course of BEP as standard treatment of VASC + CS1 NSGCT, whereas both surveillance and one course of BEP are options for VASC- CS1 NSGCT.
- Subjects
DRUG efficacy; ADJUVANT treatment of cancer; GERM cell tumors; BLEOMYCIN; ETOPOSIDE; CISPLATIN; COMBINATION drug therapy
- Publication
Indian Journal of Urology, 2010, Vol 26, Issue 1, p150
- ISSN
0970-1591
- Publication type
Article