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Göteborgs universitets publikationer

Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program.

Författare och institution:
Torgrim Tandstad (-); Olav Dahl (-); Gabriella Cohn-Cedermark (-); Eva Cavallin-Stahl (-); Ulrika Stierner (Institutionen för kliniska vetenskaper, sektionen för onkologi, radiofysik, radiologi och urologi); Arne Solberg (-); Carl Langberg (-); Roy M Bremnes (-); Anna Laurell (-); Hans Wijkstrøm (-); Olbjørn Klepp (-)
Publicerad i:
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 27 ( 13 ) s. 2122-8
Artikel, refereegranskad vetenskaplig
Sammanfattning (abstract):
PURPOSE: To offer minimized risk-adapted adjuvant treatment on a nationwide basis for patients with clinical stage 1 (CS1) nonseminomatous germ-cell testicular cancer (NSGCT). The aim was to reduce the risk of relapse and thereby reducing the need of later salvage chemotherapy while maintaining a high cure rate. PATIENTS AND METHODS: From 1998 to 2005, 745 Norwegian and Swedish patients were included into a prospective, community-based multicenter Swedish and Norwegian Testicular Cancer Project (SWENOTECA) management program. Treatment strategy depended on the presence or absence of vascular tumor invasion (VASC). VASC-positive patients were recommended brief adjuvant chemotherapy (ACT) with bleomycin, etoposide, and cisplatin (BEP), whereas VASC-negative patients could choose between ACT and surveillance. RESULTS: At a median follow-up of 4.7 years, there have been 51 relapses. On surveillance, 41.7% of VASC+ patients relapsed, compared with 13.2% of VASC- patients. After one course of BEP, 3.2% of VASC+ and 1.3% of VASC- patients relapsed. The toxicity of adjuvant BEP was low. Eight patients have died, none died from progressive disease. CONCLUSION: One course of adjuvant BEP reduces the risk of relapse by approximately 90% in both VASC+ and VASC- CS1 NSGCT, and may be a new option as initial treatment for all CS1 NSGCT. One course of adjuvant BEP for VASC+ CS1 reduces the total burden of chemotherapy compared with surveillance or two courses of BEP. SWENOTECA currently recommends one course of BEP as standard treatment of VASC+ CS1 NSGCT, whereas both surveillance and one course of BEP are options for VASC- CS1 NSGCT.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
Klinisk medicin ->
Cancer och onkologi
Adult, Antineoplastic Combined Chemotherapy Protocols, administration & dosage, adverse effects, therapeutic use, Bleomycin, administration & dosage, adverse effects, Chemotherapy, Adjuvant, Cisplatin, administration & dosage, adverse effects, Etoposide, administration & dosage, adverse effects, Humans, Male, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Neoplasm Staging, Neoplasms, Germ Cell and Embryonal, drug therapy, mortality, pathology, Prospective Studies, Testicular Neoplasms, drug therapy, mortality, pathology
Postens nummer:
Posten skapad:
2009-10-20 12:48
Posten ändrad:
2010-02-15 17:26

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