T Tandstad1, O Ståhl2, U Håkansson3, O Dahl4, H S Haugnes5, O H Klepp6, C W Langberg7, A Laurell8, J Oldenburg7, A Solberg9, K Söderström10, E Cavallin-Ståhl2, U Stierner11, R Wahlquist12, N Wall13, G Cohn-Cedermark14. 1. The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway. Electronic address: torgrim.tandstad@stolav.no. 2. Department of Oncology, Skane University Hospital, Lund. 3. Department of Urology, Skåne University Hospital, Malmö, Sweden. 4. Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen; Haukeland University Hospital, Bergen. 5. Institute of Clinical Medicine, University of Tromsø, Tromsø; University Hospital of North Norway, Tromsø. 6. Department of Oncology, Ålesund Hospital, Ålesund. 7. Department of Oncology, Oslo University Hospital, Oslo, Norway. 8. Department of Oncology, Uppsala University Hospital, Uppsala. 9. The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway. 10. The Cancer Clinic, Norrland University Hospital, Umeå. 11. Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden. 12. Department of Urology, Oslo University Hospital, Oslo, Norway. 13. Institute of Clinical and Experimental Medicine, University of Linköping, Linköping. 14. Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
Abstract
BACKGROUND: SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results. PATIENTS AND METHODS: In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study. RESULTS: At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%. CONCLUSIONS: The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.
BACKGROUND:SWENOTECA has since 1998 offered patients with clinical stage I (CS I) nonseminoma, adjuvant chemotherapy with one course of bleomycin, etoposide and cisplatin (BEP). The aim has been to reduce the risk of relapse, sparing patients the need of toxic salvage treatment. Initial results on 312 patients treated with one course of adjuvant BEP, with a median follow-up of 4.5 years, have been previously published. We now report mature and expanded results. PATIENTS AND METHODS: In a prospective, binational, population-based risk-adapted treatment protocol, 517 Norwegian and Swedish patients with CS I nonseminoma received one course of adjuvant BEP. Patients with lymphovascular invasion (LVI) in the primary testicular tumor were recommended one course of adjuvant BEP. Patients without LVI could choose between surveillance and one course of adjuvant BEP. Data for patients receiving one course of BEP are presented in this study. RESULTS: At a median follow-up of 7.9 years, 12 relapses have occurred, all with IGCCC good prognosis. The latest relapse occurred 3.3 years after adjuvant treatment. The relapse rate at 5 years was 3.2% for patients with LVI and 1.6% for patients without LVI. Five-year cause-specific survival was 100%. CONCLUSIONS: The updated and expanded results confirm a low relapse rate following one course of adjuvant BEP in CS I nonseminoma. One course of adjuvant BEP should be considered a standard treatment in CS I nonseminoma with LVI. For patients with CS I nonseminoma without LVI, one course of adjuvant BEP is also a treatment option.
Authors: Stanley A Yap; Lindsay M Yuh; Christopher P Evans; Marc A Dall'Era; Rebecca M Wagenaar; Rosemary Cress; Primo N Lara Journal: World J Urol Date: 2016-06-15 Impact factor: 4.226
Authors: Salim K Cheriyan; Marilin Nicholson; Ahmet M Aydin; Mounsif Azizi; Charles C Peyton; Wade J Sexton; Scott M Gilbert Journal: Transl Androl Urol Date: 2020-01