Abstract | PURPOSE: Controversy arises regarding the optimal management of patients with nonseminomatous germ cell tumor (NSGCT) who achieve a serologic and radiographic complete remission (CR) to systemic chemotherapy. Some authors recommend postchemotherapy retroperitoneal lymph node dissection (PC-RPLND), whereas others omit surgery and observe these patients. In an attempt to address this question, we report the long-term follow-up of patients treated at Indiana University who were observed without PC-RPLND. PATIENTS AND METHODS: This is a retrospective analysis of patients with NSGCT who achieved a CR to first-line chemotherapy and were monitored without further therapy. CR was defined as normalization of serum tumor markers and resolution of radiographic disease (residual mass < 1 cm). RESULTS: One hundred forty-one patients were identified. Five patients (4%) had less than 2 years of follow-up. After a median follow-up of 15.5 years, 12 patients (9%) experienced relapse. Of these 12 patients, eight patients currently have no evidence of disease (NED), and four patients died of disease. The estimated 15-year recurrence-free survival (RFS) and cancer-specific survival rates were 90% and 97%, respectively. The estimated 15-year RFS for good-risk patients (n = 109) versus intermediate- or poor-risk patients (n = 32) was 95% and 73% (P = .001), respectively. Six patients (4%) experienced recurrence in the retroperitoneum, of whom two patients died of disease. Five patients had late relapse (range, 3 to 13 years), including two patients in the retroperitoneum. All five patients currently have NED. CONCLUSION: Patients obtaining a CR after first-line chemotherapy can be safely observed without PC-RPLND. Relapses are rare and potentially curable with further treatment.
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Authors | Yaron Ehrlich, Mary J Brames, Stephen D W Beck, Richard S Foster, Lawrence H Einhorn |
Journal | Journal of clinical oncology : official journal of the American Society of Clinical Oncology
(J Clin Oncol)
Vol. 28
Issue 4
Pg. 531-6
(Feb 01 2010)
ISSN: 1527-7755 [Electronic] United States |
PMID | 20026808
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adolescent
- Adult
- Antineoplastic Combined Chemotherapy Protocols
(therapeutic use)
- Cisplatin
(therapeutic use)
- Follow-Up Studies
- Humans
- Lymph Node Excision
- Male
- Middle Aged
- Neoplasm Recurrence, Local
(prevention & control)
- Remission Induction
- Retroperitoneal Space
- Retrospective Studies
- Testicular Neoplasms
(drug therapy, pathology)
- Time Factors
- Young Adult
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