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Is surveillance for stage 1 germ cell tumours of the testis appropriate outside a specialist centre?
Author(s) -
Adam Jones,
Fergus Jn,
JudyAnne W. Chapman,
L.E. Houghton
Publication year - 1999
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1046/j.1464-410x.1999.00058.x
Subject(s) - medicine , seminoma , radiation therapy , etoposide , bleomycin , stage (stratigraphy) , chemotherapy , surgery , germ cell tumors , immature teratoma , dysgerminoma , teratoma , ovary , paleontology , biology
Objective To assess the results of treatment for stage 1 germ cell tumours of the testis, outside a specialist centre. Patients and methods From May 1984 until March 1996, 123 patients with stage 1 disease were treated at our institution. Sixty patients with seminoma and 31 with teratoma were treated with orchidectomy only and surveillance; 32 patients with stage 1 seminoma elected for orchidectomy and adjuvant radiotherapy. The mean ages were 40, 31 and 35 years, and the median follow‐up 52, 47 and 49 months, respectively. Results There were no disease‐ or treatment‐related deaths. However, 18 (30%) patients with seminoma treated by orchidectomy only relapsed (median time 8 months, range 3–19); 14 of these responded to radiotherapy, three to radiotherapy and chemotherapy for second relapses outside the irradiated fields, and one to chemotherapy initially, for large‐volume relapse. Fifteen (48%) patients with teratoma relapsed (median time 3 months, range 1–12); all responded to 4–6 courses of bleomycin/etoposide/cisplatin chemotherapy. One patient had a second relapse and is currently disease‐free 3 years after surgical excision of a lung metastasis. Conclusion These results show that stage 1 testis tumours can be managed successfully in a district general hospital. However, we are concerned about the high relapse rates and are now attempting to identify patients at greater risk of recurrence, to consider adjuvant therapy in this group.