903 Risk-adapted treatment of clinical stage 1 (CS1) nonseminoma testis cancer (NSTC)

Abstract

246 patients (pts) with CSI NSTC were included into a prospective multicenter protocol during 1990–94 and treated according to 3 risk strata: Pts without tumor cell invasion of vascular structures in the testis (VASC–) and elevated serum AFP levels (AFP+) at orchiectomy were considered low risk (LR) and surveilled only. VASC– & AFP– or VASC+ & AFP+ pts were presumed intermediate risk (IR) and path. staged (PS) by retroperitoneal lymph node dissection (RPLND). VASC+ & AFP− pts were regarded as high risk (HR) and received adjuvant chemotherapy (BEP × 3) Preliminary results at a median obs, time of 32 months: Crude survival of all 246 pts are 100% and all relapsing pts are in remission. Of 225 fully evaluable pts: Relapse rate in the 99 LR pts are 23% and 76% had elevated serum tumor markers at relapse. One of 32 (3%) HR pts relapsed (resectable retroperitoneal mature teratoma). Of 94 IR pts 38% had either PS2 at RPLND or relapsed despite PSI. AFP status at orchiectomy had no real predictive value for subclinical metastases in this study, but may indicate increased safety during surveillance by early warning of relapse. 246 patients (pts) with CSI NSTC were included into a prospective multicenter protocol during 1990–94 and treated according to 3 risk strata: Pts without tumor cell invasion of vascular structures in the testis (VASC–) and elevated serum AFP levels (AFP+) at orchiectomy were considered low risk (LR) and surveilled only. VASC– & AFP– or VASC+ & AFP+ pts were presumed intermediate risk (IR) and path. staged (PS) by retroperitoneal lymph node dissection (RPLND). VASC+ & AFP− pts were regarded as high risk (HR) and received adjuvant chemotherapy (BEP × 3) Preliminary results at a median obs, time of 32 months: Crude survival of all 246 pts are 100% and all relapsing pts are in remission. Of 225 fully evaluable pts: Relapse rate in the 99 LR pts are 23% and 76% had elevated serum tumor markers at relapse. One of 32 (3%) HR pts relapsed (resectable retroperitoneal mature teratoma). Of 94 IR pts 38% had either PS2 at RPLND or relapsed despite PSI. AFP status at orchiectomy had no real predictive value for subclinical metastases in this study, but may indicate increased safety during surveillance by early warning of relapse.