RESUMEN
PURPOSE: Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT), and adjuvant chemotherapy has been accepted in high-risk CSI NSGCTT. Because of the late toxicity of standard radiotherapy in CSI testicular seminoma (SGCTT), this therapeutic approach has been accepted also in the management of CSI SGCTT. In the current study, we analyzed single-center experience with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy) in patients with CSI SGCTT. PATIENTS AND METHODS: The study analyzed a total of 90 patients collected at a single center from April 2008 to March 2015 with CSI SGCTT who were stratified into two groups according to risk-adapted therapeutic approaches. RESULTS: In the group A (low-risk CSI SGCTT-no rete testis invasion, tumor size <4 cm, pT1 stage), which consisted of 74 patients who underwent surveillance, relapse occurred in seven (9.5 %) patients after a mean follow-up of 14.5 months. In the group B (high-risk CSI SGCTT-rete testis invasion, tumor size >4 cm or pT ≥ 2 stage), which consisted of 16 patients who were treated with adjuvant chemotherapy, relapse occurred in two (12.5 %) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100 %. The statistically significant difference in progression-free survival between these two groups was not found. CONCLUSIONS: Radiotherapy is currently not recommended as an adjuvant treatment in CSI SGCTT patients. The benefit of using risk-adapted therapeutic approaches in CSI SGCTTs patients is evident.
Asunto(s)
Quimioterapia Adyuvante/métodos , Recurrencia Local de Neoplasia/patología , Neoplasias de Células Germinales y Embrionarias , Orquiectomía , Seminoma , Neoplasias Testiculares , Adulto , Manejo de la Enfermedad , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/mortalidad , Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias de Células Germinales y Embrionarias/cirugía , Orquiectomía/efectos adversos , Orquiectomía/métodos , Pronóstico , Ajuste de Riesgo , Seminoma/tratamiento farmacológico , Seminoma/mortalidad , Seminoma/patología , Seminoma/cirugía , Eslovaquia/epidemiología , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/mortalidad , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugíaRESUMEN
Surveillance after orchiectomy alone has become popular in the management of clinical stage I of nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high-risk of relapse led to a search for risk factors in CSI NSGCTT. The aim of the current study was to analyze longterm experiences with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy). From 1/â1992 to 2/â2015, a total of 454 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. In Group A (low-ârisk CSI NSGCTT), which consisted of 287 patients who underwent surveillance, relapse occurred in 48 (16.7%) patients with a median followup of 7.0 months. Six patients (2.1%) of this group died with a median followup of 34.3 months. In Group B (high-risk CSI NSGCTT), which consisted of 167 patients who were treated with adjuvant chemotherapy, relapse occurred in two (1.2%) patients with a median followup of 56.2 months. One patient (0.6%) died 139.4 months following orchiectomy. Statistically significant difference in progression free survival between these two groups was found, but no significant difference in overall survival.Key words: testicular cancer -â surveillance -â adjuvant chemotherapy -â disease progression.