903 Risk-adapted treatment of clinical stage 1 (CS1) nonseminoma testis cancer (NSTC)

Patients with non-seminoma germ cell tumours treated in a minor oncology department: the importance of multi-institutional protocols and research collaboration

“…In our series, 29% of those subjected to RPLND during the early part of the period and 22% of low-risk patients following the surveillance program in the latter part of the period eventually relapsed. In contrast, none of the high-risk stage I patients treated with one or two courses chemotherapy relapsed, corroborating the very low relapse risk after chemotherapy treatment to high risk patients, reported by Klepp and co-workers [13]. All patients relapsing after RPLND or surveillance were treated successfully with chemotherapy and are without evidence of disease.…”

“…From 1990 to 1994 (SWENOTECA II), patients in clinical stage I were treated according to a relapse risk assessment based on the presence of vascular invasion in the tumour specimen and/or positive preoperative tumour markers [13]. Low-risk patients followed a surveillance program, intermediate-risk patients underwent RPLND, while high-risk patients were treated with three courses of BEP-20.…”

Risk factors for relapse in stage I non-seminomatous germ-cell tumors: Preliminary results of the German multicenter trial

“…On this basis, prospective clinical trials have been initiated in which the identified risk factors were used for reaching a therapeutic decision (Table V). Low-risk patients, as predicted by absence of VI and/or Ͻ50% embryonal carcinoma, showed relapse rates under surveillance between 0% and 22% (Kratzik et al, 1996, Klepp et al, 1997Böhlen et al, 1997;Ondrus et al, 1998). High-risk patients were treated by chemotherapy and showed tumor relapse rates of 0% to 4%.…”

“…Very preliminary results of the German Multicenter Trial suggest an inferior prediction for low-risk patients when risk factor analysis and/or CT staging are performed in non-specialized centers. Moul et al (1994) 92 ϩ ϩ ϩ ϩ -de Riese et al (1994) 102 ϩ Ϫ ϩ ϩ % Aneuploid S-phase Albers et al (1997) 78 ϩ ϩ ϩ ϩ MIB-I Heidenreich et al (1998) 149 ϩ ϩ ϩ ϩ - Kratzik et al (1996) 201 VI VI Ϫ = surveillance VI ϩ = 2 ϫ PEB 14% 4% Klepp et al (1997) 237 VI AFP …”

Current Concepts in Management of Stage I NSGCT

“…Risk-adapted treatment is based on the risk factor, vascular invasion. Stratifying patients with CS1 NSGCT according to their presumed risk of relapse is a rational option, as several studies have reported similar survival rates and a final cure rate close to 100% with all available treatment options using the risk-stratifying approach [28,[33][34][35][36][37][38][39][40][41][42][43].…”