Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer Group (GG).

OBJECTIVE: To describe the clinical characteristics and treatment results obtained with the application of a homogeneous treatment protocol in 1490 patients with germ-cell tumours (GCT) registered in the 55 hospitals belonging to the Spanish Germ-Cell Cancer Group (GG) during the period between January 1994 and April 2001. METHODS: In general, surveillance was the common policy for stage I patients without local poor prognosis factors, whereas they received adjuvant chemotherapy in case those factor were present. Chemotherapy schedules used in advanced cases were cisplatin and etoposide (EP) for seminoma and BEP or BOMP-EPI in non-seminoma, according to whether the patient was in the good or poor prognosis IGCCCG (International Germ-Cell Cancer Collaborative Group) group. Excision of residual masses was mandatory in non-seminomatous germ-cell tumour (NSGCT). RESULTS: Initial local symptomatology was increased testis size in 90% of cases. Sonography was an excellent diagnostic tool to suggest tumour. Non-seminoma (64.2%) was more frequent than seminoma (35.8%). Approximately 10% had the antecedent of cryptorchidism. Non-seminoma patients were 7 years younger than seminoma. Right testis was involved predominantly. Pre-orchidectomy tumour markers were elevated in 21% of seminoma (betaHGC) and 79% in non-seminoma (alphaFP and/or betaHGC). Scrotum violation occurred in only 1.8%. There were significant differences among stage I and the IGCCCG prognosis groups related to a longer interval between the first symptom and orchiectomy. Eighteen percent of non-seminomatous germ-cell tumour belonged to the poor prognosis IGCCCG group. With a median follow-up to 33 months, this series has achieved a 3 year overall survival of 98% for seminoma and 94% for non-seminoma. Only 10% of excised residual masses present after chemotherapy contained malignant cells. CONCLUSION: Spanish GCT have a similar clinical pattern to that described in the other occidental countries except for a slight increased proportion of non-seminoma upon seminoma. Co-operative groups as GG are unique structures to obtain quick and wide experience on the treatment of testis tumours, contributing to achieve a high cure rate.

[Towards the medicine of the 21st century]. / Hacia la Medicina del Siglo XXI.

The author highlights the role of the physician opposite the technological revolution and the importance of clinical judgement as a balancing factor as well as the imperative need for a close collaboration between the physician and health institutions, insurance companies and patients, so as to better utilize resources in the face of rising living expenses, in order to achieve excellent care through accurate diagnosis and effective and timely therapy.

Hacia la Medicina del Siglo XXI / Towards the medicine of the 21st century

The author highlights the role of the physician opposite the technological revolution and the importance of clinical judgement as a balancing factor as well as the imperative need for a close collaboration between the physician and health institutions, insurance companies and patients, so as to better utilize resources in the face of rising living expenses, in order to achieve excellent care through accurate diagnosis and effective and timely therapy

[Genetic and epidemiologic aspects in diabetes mellitus]. / Aspectos géneticos y epidemiológicos en diabetes mellitus.

Epidemiology and genetics go hand in hand in Diabetes, confirming and providing clinical bases foreseen by our predecessors. They provide more solid scientific bases to search for markers that will allow us to detect susceptible populations earlier and thus eliminate or correct risk factors. We may be able to select the subjects at greater risk, for appropriate pre-marital and gestational counseling. This is a wide and promising field for investigation that will result in better prevention and diagnosis, as well as in improved therapy and prognosis.