Annals of Oncology Advance Access originally published online on August 26, 2005
Annals of Oncology 2005 16(12):1915-1920; doi:10.1093/annonc/mdi397
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© 2005 European Society for Medical Oncology
Multicentre risk-adapted management for stage I non-seminomatous germ cell tumours
The Spanish Germinal Group, Spain
* Correspondence to: Dr P. Maroto, Hospital Sant Pau, C/Padre Ma Claret No. 167, 08024 Barcelona, Spain. Tel: +34-9329-19276; Fax: +34-9329-19000; E-mail: jmaroto{at}hsp.santpau.es
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 (bleomicin 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.
Key words: non-seminomatous germ cell tumours, stage I, risk-adapted surveillance
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