Annals of Oncology Advance Access published online on October 29, 2009
Annals of Oncology, doi:10.1093/annonc/mdp473
Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy
1 Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada
2 Department of Medicine, Earle A. Chiles Research Institute, Providence Cancer Center
3 Section of Urologic Oncology, Division of Urology and Renal Transplantation, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
4 Department of Urological Sciences, University of British Columbia, The Prostate Center at Vancouver General Hospital, Vancouver, British Columbia, Canada
5 Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA
* Correspondence to: Dr C. R. Nichols, Earle A. Chiles Research Institute, Providence Cancer Center, 4805 North East Glisan Street, Ste 2N 35, Portland, OR 97213, USA. Tel: +1-503-215-6259; Fax: +1-503-215-6841; E-mail: craig.nichols{at}providence.org
Background: With treatment leading to nearly uniform cure in clinical stage I nonseminomatous testicular cancer (CSI-NSGCT), diminishing treatment-related morbidity has become the primary concern. This study examined feasibility and outcome of active surveillance as treatment in an unselected CSI patient population.
Materials and methods: All patients with CSI-NSGCT referred from 1998 to 2007 to the British Columbia Cancer Agency and the Oregon Testis Cancer Program were retrospectively reviewed. A total of 233 patients were identified, of which 223 chose active surveillance.
Results: Vascular invasion (VI) was absent, present and unknown in 66%, 27% and 7% of cases, respectively. Overall, 49% of patients had embryonal predominant disease. Fifty-nine patients (26%) relapsed, all but one with good prognosis disease. VI was present in 30 relapsed patients. Most patients relapsed within 2 years (88%). Only 7 of 223 patients (3%) relapsed beyond 2 years. All relapses were in long-term remission following chemotherapy with or without retroperitoneal lymph node dissection (RPLND). Only 17 of 223 patients (8%) required postorchiectomy surgery. Disease-specific survival is 100% after a median follow-up of 52 months (3–136). No patient has required second-line chemotherapy.
Conclusions: Active surveillance for all CSI-NSGCT patients is associated with excellent outcomes comparable with the best results reported with primary RPLND or adjuvant chemotherapy. Nearly 75% of patients are spared any therapy after orchiectomy.
nonseminomatous testicular cancer, stage I, surveillance, testis cancer
Received for publication May 26, 2009. Revision received August 9, 2009. Accepted for publication August 27, 2009.