ABSTRACT
BACKGROUND: The Spanish Germ Cell Group is composed of 60 centres. Our challenge was to define a surveillance protocol that would be safe and suitable regardless of population size or geographic coverage. METHODS: From January 1994 to January 2004, 589 patients with stage I non-seminomatous germ cell tumours entered a risk-adapted surveillance protocol after orchiectomy. Patients with vascular or local invasion of adjacent structures (231/589; 39%) received two cycles of BE400P (bleomycin 30 U/week, etoposide 100 mg/m2 x4, cisplatinum 25 mg/m2 x4). Other patients (358/589; 61%) were kept on close follow-up (chest X-ray; serum tumour markers: first year every 2 months, second year every 3 months, third year every 4 months; abdominal computed tomography scans at every other outpatient control). The outcomes selected for the study were feasibility, relapse rate and number of patients lost to follow-up and mortality. RESULTS: Median follow-up was 40 months. In the surveillance group, 21 patients were lost to follow-up. In the chemotherapy group, two patients relapsed at 12 and 14.5 months and they are presently free of disease. In the surveillance group, 71 (19%) patients relapsed, of which 55 (71%) relapsed within the first year. Five (1.4%) patients died of their cancer. Factors associated with relapse were embryonal carcinoma and vascular invasion in patients who refused chemotherapy. CONCLUSIONS: Our risk-adapted surveillance protocol provided a low rate of recurrences.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Risk Management , Testicular Neoplasms/drug therapy , Adolescent , Adult , Biomarkers, Tumor/blood , Bleomycin/administration & dosage , Carcinoma, Embryonal/drug therapy , Carcinoma, Embryonal/metabolism , Carcinoma, Embryonal/surgery , Chemotherapy, Adjuvant , Choriocarcinoma/drug therapy , Choriocarcinoma/metabolism , Choriocarcinoma/surgery , Etoposide/administration & dosage , Feasibility Studies , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Recurrence, Local , Orchiectomy , Prognosis , Seminoma/drug therapy , Seminoma/metabolism , Seminoma/surgery , Survival Rate , Teratoma/drug therapy , Teratoma/metabolism , Teratoma/surgery , Testicular Neoplasms/metabolism , Testicular Neoplasms/surgerySubject(s)
Analgesia, Epidural , Analgesia, Obstetrical , Autoimmune Diseases/complications , Paraparesis/etiology , Polymyositis/complications , Puerperal Disorders/etiology , Adult , Autoimmune Diseases/diagnosis , Diagnosis, Differential , Female , Hematoma/diagnosis , Humans , Polymyositis/diagnosis , Remission, Spontaneous , Spinal Cord Injuries/diagnosisABSTRACT
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