Abstract
4524 Background: Management of stage I NSGCT is controversial. Our challenge in the Spanish Germ Cell Group composed of 60 hospitals was to reduce morbidity through a risk adapted surveillance protocol useful regardless of size of Hospital or geographical differences. Methods:From I/94 to II/2003, 593 patients with stage I NSGCT entered a risk-adapted surveillance protocol. 360/593, 60.7% were in close follow-up (chest X ray and serum tumor markers every 2 m first year, every 3 m second year, every 4 m the third; abdominal Ct scan every other outpatient visit). 233/593, 39.3% received adjuvant BEP because vascular invasion in 150 patients, invasion of structures (considered as risk factor the first 3 years of our protocol) in 75 and other reasons in 8 (i.e. patient's choice). Chemotherapy consisted until 1999 of 3 cycles of Spanish BEP (Bleomicin 30 U/wk, Etoposide 100 mg/m2x4, Cisplatinum 25 mg/m2x4), later of 2 cycles and 21 patients received only one cycle. Results: Median follow-up: 40 m. Chemotherapy: No cancer specific mortality. Only 3 patients relapsed, at 12, 12.7 and 14.5 m and presently free of disease. Surveillance: 18 patients lost on follow-up. Six patients died of cancer. 73 (20%) patients relapsed, most of them within the first year. Seven years disease free survival of 76%. Relapses under surveillance: Only factor associated to relapse was Embrionary Carcinoma as the main component of histology.Eight patients presented a second testicular tumor on follow-up. Conclusions: Risk adapted surveillance provided a low rate of recurrences. In our area, reduction of relapses may reduce morbidity (lower number of surgery procedures or cycles per patient). Spanish BEP reduced number of recurrences almost to zero. Patients who received chemotherapy may simplify their follow-up. Further information about toxicity and pattern of relapse will be provided at the meeting. No significant financial relationships to disclose.
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