PURPOSE: From 1995 to 2003, 603 adult patients from Sweden and Norway with metastatic testicular nonseminomatous germ cell tumor (NSGCT) were included prospectively in a population-based protocol with strict guidelines for staging, treatment, and follow-up. Patients with extragonadal primary tumor or previous treatment for contralateral testicular tumor were excluded. The basic strategy was to individualize treatment according to initial tumor marker response. METHODS: Initial treatment for all patients was two courses of standard bleomycin, etoposide, and cisplatin (BEP), with tumor markers analyzed weekly. Good response was defined as a half-life (t(1/2)) for α-fetoprotein (AFP) of ≤ 7 days and/or for β-human chorionic gonadotropin (β-HCG) of ≤ 3 days. Patients with prolonged marker t(1/2) (ie, poor response) received intensification with addition of ifosfamide (BEP-if/PEI) in step 1. If poor response continued, the treatment was intensified with high-dose chemotherapy with stem-cell rescue as step 2. RESULTS: Overall, 99% of all patients with metastatic testicular NSGCT in the population were included in the protocol. Median follow-up was 8.2 years. Seventy-seven percent of the patients were treated with BEP alone; 18% received intensification step 1%, and 5% received intensification step 2. Grouped according to International Germ Cell Consensus Classification, 10-year overall survival was 94.7% in good-prognosis patients, 90.0% in intermediate-prognosis patients, and 67.4% in poor-prognosis patients. CONCLUSION: With detailed treatment protocols and a dedicated collaborative group of specialists, treatment results comparable to those reported from large single institutions can be achieved at national level. With the treatment principles used in Swedish-Norwegian Testicular Cancer Group study SWENOTECA IV, the survival of intermediate-prognosis patients is remarkable and close to that of good-prognosis patients.
PURPOSE: From 1995 to 2003, 603 adult patients from Sweden and Norway with metastatic testicular nonseminomatous germ cell tumor (NSGCT) were included prospectively in a population-based protocol with strict guidelines for staging, treatment, and follow-up. Patients with extragonadal primary tumor or previous treatment for contralateral testicular tumor were excluded. The basic strategy was to individualize treatment according to initial tumor marker response. METHODS: Initial treatment for all patients was two courses of standard bleomycin, etoposide, and cisplatin (BEP), with tumor markers analyzed weekly. Good response was defined as a half-life (t(1/2)) for α-fetoprotein (AFP) of ≤ 7 days and/or for β-human chorionic gonadotropin (β-HCG) of ≤ 3 days. Patients with prolonged marker t(1/2) (ie, poor response) received intensification with addition of ifosfamide (BEP-if/PEI) in step 1. If poor response continued, the treatment was intensified with high-dose chemotherapy with stem-cell rescue as step 2. RESULTS: Overall, 99% of all patients with metastatic testicular NSGCT in the population were included in the protocol. Median follow-up was 8.2 years. Seventy-seven percent of the patients were treated with BEP alone; 18% received intensification step 1%, and 5% received intensification step 2. Grouped according to International Germ Cell Consensus Classification, 10-year overall survival was 94.7% in good-prognosis patients, 90.0% in intermediate-prognosis patients, and 67.4% in poor-prognosis patients. CONCLUSION: With detailed treatment protocols and a dedicated collaborative group of specialists, treatment results comparable to those reported from large single institutions can be achieved at national level. With the treatment principles used in Swedish-Norwegian Testicular Cancer Group study SWENOTECA IV, the survival of intermediate-prognosis patients is remarkable and close to that of good-prognosis patients.
Authors: Elio Mazzone; Sophie Knipper; Francesco A Mistretta; Zhe Tian; Carlotta Palumbo; Denis Soulieres; Ottavio De Cobelli; Francesco Montorsi; Shahrokh F Shariat; Fred Saad; Alberto Briganti; Pierre I Karakiewicz Journal: World J Urol Date: 2019-08-28 Impact factor: 4.226
Authors: Sven-Erik Olofsson; Björn Nodin; Alexander Gaber; Jakob Eberhard; Mathias Uhlén; Karin Jirström; Mats Jerkeman Journal: PLoS One Date: 2015-03-26 Impact factor: 3.240
Authors: J Beyer; P Albers; R Altena; J Aparicio; C Bokemeyer; J Busch; R Cathomas; E Cavallin-Stahl; N W Clarke; J Claßen; G Cohn-Cedermark; A A Dahl; G Daugaard; U De Giorgi; M De Santis; M De Wit; R De Wit; K P Dieckmann; M Fenner; K Fizazi; A Flechon; S D Fossa; J R Germá Lluch; J A Gietema; S Gillessen; A Giwercman; J T Hartmann; A Heidenreich; M Hentrich; F Honecker; A Horwich; R A Huddart; S Kliesch; C Kollmannsberger; S Krege; M P Laguna; L H J Looijenga; A Lorch; J P Lotz; F Mayer; A Necchi; N Nicolai; J Nuver; K Oechsle; J Oldenburg; J W Oosterhuis; T Powles; E Rajpert-De Meyts; O Rick; G Rosti; R Salvioni; M Schrader; S Schweyer; F Sedlmayer; A Sohaib; R Souchon; T Tandstad; C Winter; C Wittekind Journal: Ann Oncol Date: 2012-11-14 Impact factor: 32.976