[Follow-up of patients with localized germinal testicular tumors: 6 years' experience at the "Santa Creu i Sant Pau" Hospital]. / Seguimiento en pacientes con tumores germinales de testículo localizado: seis años de experiencia del Hospital de la "Santa Creu i Sant Pau".

From 1984 to 1989, 89 patients with stage I testicular carcinoma had been treated and followed at the Oncology Unit of the "Santa Creu i Sant Pau" Hospital. The histologic diagnosis was that of seminoma in 53 and nonseminomatous tumor in 36 patients. Treatment considered of inguinal orchidectomy and close clinical surveillance. Eight of the patients that had been diagnosed as having seminoma received adjuvant radiotherapy since follow-up could not be possible. Recurrence was observed in 5 of the 45 (11 por 100) patients with seminoma and 11 of the 36 (31 por 100) with nonseminomatous tumor that could be followed. All recurrences received chemotherapy (cisplatin and etoposide) which achieved complete remission. All of the patients are currently tumor-free after a mean follow-up of 34 months for the patients with seminoma, 39 months for those with nonseminomatous tumor and no recurrence, and 20 months for the nonseminomatous tumors that had recurred. Surveillance following orchidectomy for stage I testicular tumors is a valid approach if the patient can be followed correctly and achieves the same results as other more aggressive therapeutic strategies.

Intensive chemotherapy in poor-prognosis nonseminomatous germ cell tumors of the testis.

Forty-one patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) of the testis were treated between 1980 and 1989. This group was defined by the presence of one of the following features: multiple large lung metastases, bone, liver or brain metastases, abdominal mass greater than 10 cm, abdominal mass greater than 5 cm with high serum concentration of the tumor markers [alpha-fetoprotein (alpha FP) greater than 500 kU/l or beta-subunit of human chorionic gonadotropin (beta HCG) greater than 1,000 IU/l) or very high serum tumor marker concentrations (alpha FP greater than 5,000 kU/l or beta HCG greater than 10,000 IU/l). The first 21 patients were treated with cisplatin, vinblastine, bleomycin (PVB) chemotherapy and the following 20 with an intense, alternating 6-drug chemotherapy consisting of cisplatin, bleomycin, vincristine, methotrexate, etoposide and ifosfamide (BOMP/EPI). Surgery of residual masses was performed when tumor markers were negative. Fifteen patients (71.4%) in the PVB group and 18 patients (85%) in the BOMP/EPI group remained disease-free at a median follow-up of 67 and 41 months, respectively. None of the resected masses in the BOMP/EPI group contained malignant disease whereas viable carcinoma was found in 5 of 14 (26.4%) patients in the PVB group. The toxicity of the BOMP/EPI regimen was severe but tolerable. Intensive chemotherapy regimen seems to be useful in this subset of patients, but randomised prospective trials comparing these with standard chemotherapy are necessary.

A phase II trial of carboplatin in untreated patients with extensive stage small cell lung cancer.

Twenty-five untreated patients with extensive stage small cell lung cancer (ESSCLC) were treated with carboplatin (CBDCA) (500 mg/m2) given as a 24-hour infusion every 21 days. Thirteen patients responded for an overall response rate of 52% (95% confidence limits, 32% to 72%) with 3 complete responses (CR) (12%; 95% confidence limits, 0% to 25%). The median duration of response was 4.5 months. The median survival time was 8 months with three long-term survivors (12%) at 27, 33, and 43 months from the start of CBDCA treatment. Ninety-two courses of CBDCA were administered and one treatment-related death occurred. The main toxicity was myelosuppression. Grade 3 or 4 hematologic toxicity (hemoglobin level, less than 8 g/dl; granulocyte count, less than 1900/microliters; and platelet count, less than 49,000/microliters) was observed as follows: neutropenia in 7 courses (8%) and in 7 patients (28%), decreased hemoglobin level in 13 courses (15%) and in 7 patients (28%), and decreased platelet count in 10 courses (11%) all Grade 3 and in 8 patients (32%). This study demonstrates that at this dose and schedule CBDCA is a highly active drug in ESSCLC and it has tolerable toxicity.