Abstract
Between 1979 and 1996 303 men with stage I testicular germ cell tumours (120 seminoma
and 183 non-seminomatous germ cell tumours (NSGCT)) were enrolled onto a programme
of surveillance. In our institutions the frequency of computed tomography (CT) scans
is reduced compared with other centres. For all 303 men, the median follow-up is 5.1
years (range: 0.1–21.7 years) and there have only been 3 deaths (1 from disease, 1
from neutropenic sepsis and 1 from secondary leukaemia). 52/183 (28%) patients with
NSGCT and 18/120 (15%) patients with seminoma have relapsed. The relapse-free survival
at 5 years is 82% for seminoma and 69% for NSGCT (Logrank P=0.004). All men who relapsed, except 1 man with NSGCT, were in the International
Germ Cell Cancer Collaborative Group good or intermediate prognosis group at relapse.
Half of the seminoma relapses presented with symptoms and 31% of the NSGCT relapses.
The remaining relapses were detected serologically or radiologically by the surveillance
programme. 5 men (2%) on surveillance, 3 with initial diagnosis of seminoma and 2
with NSGCT, have developed second contralateral testis tumours (all stage I seminomas).
In a well motivated centre a policy of surveillance for stage I testicular germ cell
tumours (both NSGCT and seminoma) is associated with a low mortality rate (3/303,
1%) and may have the advantage of sparing overtreatment with potentially toxic therapies
in this group of young men.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Frequency of serum tumour marker monitoring in patients with non-seminomatous germ cell tumours.Br. J. Cancer. 1990; 61: 916-918
- Nonparametric estimation from incomplete observations.J. Am. Stat. Assoc. 1958; 53: 457-481
- Design and analysis of randomised clinical trials requiring prolonged observation of each patient II.Br. J. Cancer. 1977; 35: 1-39
- International Germ Cell Consensus Classification.J. Clin. Oncol. 1997; 15: 594-603
- Surgical treatment of clinical stage a nonseminomatous testis cancer.Semin. Oncol. 1992; 19: 166-170
- Medical Research Council prospective study of surveillance for stage I testicular teratoma.J. Clin. Oncol. 1992; 10: 1762-1768
- Surveillance after orchidectomy for patients with clinical stage I nonseminomatous testis tumors.J. Clin. Oncol. 1992; 10: 564-568
- Pilot study to evaluate impact of a policy of adjuvant chemotherapy for high risk Stage 1 malignant teratoma on overall relapse rate of Stage 1 cancer patients.J. Urol. 1992; 148: 1453-1456
- Short-course adjuvant chemotherapy in high risk stage 1 nonseminomatous germ cell tumours of the testis.J. Clin. Oncol. 1996; 14: 1106-1113
- Adjuvant chemotherapy for high-risk clinical stage 1 nonseminomatous testicular germ cell cancer.J. Clin. Oncol. 1996; 14: 441-448
- Evaluation of long-term toxicity after chemotherapy for testicular cancer.J. Clin. Oncol. 1996; 14: 2923-2932
- Toxicity of treatment of germ cell tumours.Semin. Oncol. 1992; 19: 128-142
- Treatment of testicular cancer and the development of secondary malignancies.J. Clin. Oncol. 1995; 13: 283-292
- Pilot studies of 2 and 1 course carboplatin as adjuvant treatment for stage 1 seminoma.Int. J. Radiat. Oncol. Biol. Phys. 1994; 29: 3-8
- Is routine pretreatment cryopreservation of semen worthwhile in the management of patients with testicular cancer?.Br. J. Urol. 1989; 64: 524-529
- Results of semen cryopreservation in young men with testicular carcinoma and lymphoma.J. Clin. Oncol. 1986; 4: 537-539
- Late toxicity after chemotherapy of testis cancer.in: Vogelzang N Scardino P.T Shipley W.U Coffey D.S Comprehensive Textbook of Genitourinary Oncology. Williams & Wilkins, Baltimore1996: 1090-1096
- Sexuality and fertility in long-term survivors of testicular cancer.J. Clin. Oncol. 1997; 15: 1444-1448
- Results of the surveillance policy of Stage 1 nonseminomatous germ cell testicular tumours.Br. J. Urol. 1992; 70: 423-428
- Detection of recurrence in patients with clinical stage 1 nonseminomatous testicular germ cell tumours and consequences for further follow-up.J. Clin. Oncol. 1995; 13: 1188-1194
- Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965–1989); modifications of technique and impact on ejaculation.J. Urol. 1993; 149: 237-243
- Cost- and risk-benefit considerations in the management of clinical stage 1 nonseminomatous testicular tumours.Ann. Surg. Oncol. 1996; 3: 86-93
- Controversies in the management of testicular seminoma.Cancer. 1985; 55: 2296-2302
- Stage I testicular seminoma.Int. J. Radiat. Oncol. Biol. Phys. 1987; 13: 155-162
- Radiotherapy for testicular seminoma stage I.Int. J. Radiat. Oncol. Biol. Phys. 1989; 16: 383-388
- An analysis of surveillance for stage 1 combined teratoma–seminoma of the testis.Br. J. Cancer. 1996; 74: 59-62
- Testicular germ cell cancer.N. Engl. J. Med. 1997; 337: 242-253
- Radiotherapy for stage 1 seminoma testis.Radiother. Oncol. 1986; 6: 115-120
- Secondary neoplasms following treatment of malignant germ cell tumours.J. Clin. Oncol. 1993; 11: 1703-1709
Article info
Publication history
Accepted:
May 10,
2000
Received in revised form:
January 7,
2000
Received:
October 6,
1999
Identification
Copyright
© 2000 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
