Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer Journal Article
| Authors: | Stephenson, A. J.; Bosl, G. J.; Motzer, R. J.; Bajorin, D. F.; Stasi, J. P.; Sheinfeld, J. |
| Article Title: | Nonrandomized comparison of primary chemotherapy and retroperitoneal lymph node dissection for clinical stage IIA and IIB nonseminomatous germ cell testicular cancer |
| Abstract: | Purpose: Patients with clinical stage (CS) IIA and IIB nonseminomatous germ cell tumor (NSGCT) with adenopathy more than 2 cm, multiple masses, elevated serum tumor markers, or disease outside the primary landing zone have increasingly been recommended to receive primary chemotherapy over time at our institution. The impact of these selection factors on the outcome of patients managed primarily by retroperitoneal lymph node dissection (RPLND) or chemotherapy was examined. Patients and Methods: Between 1989 and 2002, 252 patients with CS IIA and IIB NSGCT were referred to our institution for initial management, of whom 136 underwent RPLND and 116 received chemotherapy and postchemotherapy RPLND. Patient information was obtained from a prospective RPLND database. Results: Proportionately more patients received chemotherapy over time (22% in 1989 to 1993 v 68% in 1999 to 2002), and the relapse-free survival (RFS) subsequently improved from 84% (1989 to 1998) to 98% (1999 to 2002; P = .004) without increasing the proportion who received any chemotherapy (70% v 79%; P = .16). By increasingly selecting patients with adverse features for primary chemotherapy, the RFS after RPLND improved from 78% to 100% (P = .019), but rates of pathologic stage II and retroperitoneal teratoma were unaffected. Retroperitoneal histology and RFS did not change over time for chemotherapy patients. Primary chemotherapy was associated with improved RFS compared with RPLND (98% v 79%; P < .001), but disease-specific survival did not differ significantly (100% v 98%; P = .3). Conclusion: Patient selection factors have significantly improved the outcome of patients with CS IIA and IIB NSGCT without substantially increasing the proportion of patients exposed to chemotherapy. © 2007 by American Society of Clinical Oncology. |
| Keywords: | cancer chemotherapy; cancer survival; controlled study; treatment outcome; disease-free survival; major clinical study; histopathology; cisplatin; cancer growth; chemotherapy, adjuvant; cancer staging; antineoplastic agent; lymph node dissection; lymphatic metastasis; neoplasm staging; lymph node excision; computer assisted tomography; antineoplastic combined chemotherapy protocols; risk assessment; testicular neoplasms; neoplasms, germ cell and embryonal; retroperitoneal neoplasms; testis cancer; non seminomatous germinoma |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 25 |
| Issue: | 35 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2007-12-10 |
| Start Page: | 5597 |
| End Page: | 5602 |
| Language: | English |
| DOI: | 10.1200/jco.2007.12.0808 |
| PUBMED: | 18065732 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 23" - "Export Date: 17 November 2011" - "CODEN: JCOND" - "Source: Scopus" |
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