Long-term followup results of 1 cycle of adjuvant bleomycin, etoposide, and cisplatin chemotherapy for high risk clinical Stage I nonseminomatous germ cell tumors of the testis: Westermann DH, Schefer H, Thalmann GN, Karamitopoulou-Diamantis E, Fey MF, Studer UE, Department of Urology, University of Bern, Bern, Switzerland

Abstract

We evaluated the long-term outcome after 1 cycle of adjuvant modified bleomycin, etoposide, and cisplatin chemotherapy in patients who underwent orchiectomy for high risk clinical Stage I nonseminomatous germ cell tumor of the testis. Between 1995 and 1999, a consecutive series of 44 patients underwent orchiectomy for clinical Stage I nonseminomatous germ cell tumor of the testis, followed by a single postoperative cycle of adjuvant modified bleomycin, etoposide, and cisplatin for vascular or lymphatic tumor invasion, and/or a predominance (50% or greater) of embryonal carcinoma. Four of the 44 patients were excluded from analysis. Of the patients, 35 had no evidence of disease at a median followup of 99 months (range 60–134). One patient with progression after 13 months showed complete remission after 3 cycles of salvage bleomycin, etoposide, and cisplatin chemotherapy but he died of pneumonia 4 weeks after the third course. Two patients underwent orchiectomy for contralateral testis cancer at 18 and 42 months, respectively, followed by an additional 3 cycles of adjuvant chemotherapy. They remained relapse-free for 4 and 92 months, respectively. The former patient was lost to follow-up after 4 months. Two other patients were disease-free at 10 and 31 months, respectively, and were lost to follow-up thereafter. Late side effects were tinnitus in 3 patients and involuntary childlessness in 3, of whom 2 had cryptorchidism of the contralateral testis. Nine patients fathered children. One cycle of bleomycin, etoposide, and cisplatin effectively decreases the risk of relapse in patients with high risk Stage I nonseminomatous germ cell tumor of the testis. It has minimal side effects and can be a valuable alternative to retroperitoneal lymph node dissection.