Risk-adapted treatment in clinical stage 1 (CS1), non-seminomatous germ cell testicular cancer (NSGCT)

Abstract

5034 Background: From 1995–2005, 874 Norwegian and Swedish CS1 NSGCT patients were included into a prospective, community-based multicenter SWENOTECA study. Methods: Patients were restaged 6 weeks after orchiectomy (orch.). Based on vascular invasion (VASC ±) in the primary tumour, and patient’s preference, close surveillance or treatment with brief adjuvant chemotherapy (ACT) with bleomycin, etoposide and cisplatin (BEP) was chosen. Results: Median follow-up is now 5.2 years. Ten patients have died during follow-up. None died from progressive cancer or from evident side effects of ACT. One patient died of a complication to salvage CT after relapse following surveillance. The toxicity of adjuvant BEP was acceptable. Only 5% of patients receiving adjuvant BEP required hospitalisation due to toxicity. Of the seven patients relapsing after ACT, six received chemotherapy as part of salvage treatment. One patient was resistant to salvage BEP, but was cured by a combination of other chemotherapy, surgery and radiation therapy. Only four relapses occurred more than three years after orch, one of these had received ACT (BEP x 1). Relapse rates according to risk group and adjuvant CT are as follows: Conclusions: Relapse rates in this cohort of patients are low. Surveillance is an excellent option for VASC - CS1 NSGCT. One course of adjuvant BEP x 1 reduces the risk of relapse by about 90% in both VASC ± CS1 NSGCT. A second course of BEP will virtually eliminate relapses in VASC + patients, however thereby increasing the total burden of chemotherapy for these young patients. There is no evidence of clinically significant chemoresistance induction or increased risk of late relapses by ACT. Preliminary and limited data of these results were published as posters at ASCO annual meeting 2003, and as a poster at ECCO 2007. Risk Group Adjuvant chemotherapy No patients No relapses Relapse rate (K-M) Median time to relapse (y) Median obs. time (y) All pts 874 69 (7.9%) 8.7% 1.0 (0.2–6.4) 5.1 VASC+ None 17 8 (47.1%) 47.1% 0.5 (0.2- 1.3) 6.5 VASC+ BEP x 1 157 5 (3.2%) 3.5% 1.1 (0.9–3.3) 4.8 VASC+ BEP x 2 70 0 0% 5.0 VASC- None 461 54 (11.7%) 12.6% 0.7 (0.2–6.4) 5.8 VASC- BEP x 1 155 2 (1.3%) 1.4% 1.2 (1.0–1,2) 4.1 VASC- BEP x 2 2 0 0% 2.9 Other 12 0 0% No significant financial relationships to disclose.