ADJUVANT CHEMOTHERAPY FOR HIGH-RISK CLINICAL STAGE-I NONSEMINOMATOUS TESTICULAR GERM-CELL CANCER - LONG-TERM RESULTS OF A PROSPECTIVE TRIAL

Purpose: To assess the impact of short-term adjuvant chemotherapy on r elapse rates, treatment-related morbidity, and long-term toxicity in p atients with clinical stage I nonseminomatous testicular germ cell tum or (NSGCT I) who carry a high risk of relapse, ie, who show blood-vess el invasion (VI) by the primary tumor. Patients and Methods: From Janu ary 1985 to January 1995, 42 NSGCT I patients with VI were treated wit h two courses of cisplatin, etoposide, and bleomycin (FEB) after orchi dectomy. Of these, 29 patients with a followup time of more than 2 yea rs are the subject of this report. NSGCT I patients without VI were as signed to a surveillance program and served as controls for the assess ment of long-term toxicity. Results: During a median follow-up time of 79 months (range, 27 to 119), two patients relapsed. One developed fu lly differentiated mature teratoma; the other was a true chemotherapy failure and again developed embryonal carcinoma. Twenty-seven patients (93%) are alive without evidence of disease; one patient (3%) died of progressive testicular cancer and another of lung cancer. The two cou rses of FEB did not cause any severe acute adverse reactions. The asse ssment of late sequels of adjuvant chemotherapy based on clinical and laboratory evidence of cardiovascular and pulmonary disease, fertility , and secondary neoplasms, as well as on a psychosocial questionnaire, did not show any significant disadvantages versus the control group. Conclusion: Adjuvant chemotherapy with two courses of PEB is an effect ive and reasonable treatment option for patients with clinical stage I NSGCT who carry a high risk of relapse. No adverse late sequelae were detected within a median follow-up time of more than 6 years. (C) 199 6 by American Society of Clinical Oncology.