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Population-Based Study of Treatment Guided by Tumor Marker Decline in Patients With Metastatic Nonseminomatous Germ Cell Tumor: A Report From the Swedish-Norwegian Testicular Cancer Group
- Source :
- Journal of Clinical Oncology. 29:2032-2039
- Publication Year :
- 2011
- Publisher :
- American Society of Clinical Oncology (ASCO), 2011.
-
Abstract
- Purpose From 1995 to 2003, 603 adult patients from Sweden and Norway with metastatic testicular nonseminomatous germ cell tumor (NSGCT) were included prospectively in a population-based protocol with strict guidelines for staging, treatment, and follow-up. Patients with extragonadal primary tumor or previous treatment for contralateral testicular tumor were excluded. The basic strategy was to individualize treatment according to initial tumor marker response. Methods Initial treatment for all patients was two courses of standard bleomycin, etoposide, and cisplatin (BEP), with tumor markers analyzed weekly. Good response was defined as a half-life (t1/2) for α-fetoprotein (AFP) of ≤ 7 days and/or for β–human chorionic gonadotropin (β-HCG) of ≤ 3 days. Patients with prolonged marker t1/2 (ie, poor response) received intensification with addition of ifosfamide (BEP-if/PEI) in step 1. If poor response continued, the treatment was intensified with high-dose chemotherapy with stem-cell rescue as step 2. Results Overall, 99% of all patients with metastatic testicular NSGCT in the population were included in the protocol. Median follow-up was 8.2 years. Seventy-seven percent of the patients were treated with BEP alone; 18% received intensification step 1%, and 5% received intensification step 2. Grouped according to International Germ Cell Consensus Classification, 10-year overall survival was 94.7% in good-prognosis patients, 90.0% in intermediate-prognosis patients, and 67.4% in poor-prognosis patients. Conclusion With detailed treatment protocols and a dedicated collaborative group of specialists, treatment results comparable to those reported from large single institutions can be achieved at national level. With the treatment principles used in Swedish-Norwegian Testicular Cancer Group study SWENOTECA IV, the survival of intermediate-prognosis patients is remarkable and close to that of good-prognosis patients.
- Subjects :
- Adult
Male
Oncology
Cancer Research
medicine.medical_specialty
Adolescent
Population
Drug Administration Schedule
Metastasis
Bleomycin
Testicular Neoplasms
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Biomarkers, Tumor
medicine
Humans
Neoplasm Metastasis
education
Etoposide
Testicular cancer
Aged
Tumor marker
Sweden
Gynecology
education.field_of_study
Ifosfamide
Norway
business.industry
Tumor Marker Response
Middle Aged
Neoplasms, Germ Cell and Embryonal
Prognosis
medicine.disease
Primary tumor
Population Surveillance
Cisplatin
business
medicine.drug
Subjects
Details
- ISSN :
- 15277755 and 0732183X
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....6847a049ad136c8c87db2f0318f48641
- Full Text :
- https://doi.org/10.1200/jco.2010.29.1278