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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

Authors :
Sven Erik Olofsson
Gabriella Cohn-Cedermark
Harald Anderson
Hans Wijkström
Olof Ståhl
Eva Cavallin-Ståhl
Roy M. Bremnes
Torgrim Tandstad
Mats Jerkeman
Arne Solberg
Olbjørn Klepp
Anna Laurell
Carl W. Langberg
Olav Dahl
Rolf Wahlqvist
Ulrika Stierner
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.

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