Abstract
Between January 1981 and December 1985, 122 patients with non-seminomatous germ cell tumours (NSGT) were seen at a regional referral centre. Of these, a total of 98 patients received chemotherapy for metastatic disease. Treatment was given within collaborative EORTC Urology group studies, all of which involved cis-platin-containing schedules. Ninety patients had tumours of testicular origin, and their 2 year actuarial survival rate is 91%; 8 had tumours of extragonadal origin and their 2 year actuarial survival is 25%. Patients with testicular tumours were subdivided by volume of metastatic disease using the recommendations of the Testicular Cancer Subgroup of the MRC Urological Cancer Working Party and survival was significantly worse in the group with very large volume metastatic disease (VLVM, 57%) compared with the groups with large volume metastases (LVM, 100%) and small volume metastases (SVM, 98%). There were 31 patients with Stage I disease at presentation; of these 6 were treated by prophylactic abdominal radiotherapy and 25 were managed by a policy of surveillance only. Seven of these Stage I patients (23%) relapsed with metastatic disease (median 8 months); all have been successfully treated with chemotherapy. These data confirm that the majority of patients now presenting with metastatic NSGCT are curable with chemotherapy, but that a small proportion with very large volume metastases or extragonadal tumours require alternative chemotherapy schedules.
Highlights
Of the 31 patients (26%) who were clinically Stage I, 16 entered a surveillance study conducted by the MRC Testicular Cancer Subgroup and were monitored with monthly clinical examination, chest radiology and tumour marker estimation with bimonthly CT scanning
There have been 7 relapses in the whole group (23%) all of whom achieved complete remission with chemotherapy and their disease free survival at a minimum of 2 years from diagnosis is 100%
The poor prognosis in patients with extragonadal tumour is probably related to volume of disease at presentation, since 5 of the 8 patients had tumour which would have been defined as very large volume (VLVM)
Summary
The aim of this study was to review experience in the presentation and management of patients with this disease, over a 5 year period at a single regional referral centre, and to place this in perspective against the background of national data
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