📃 Paper Title: Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program
🧍 Author: Tandstad
🕒 Year: 2009
📚 Journal: Journal of Clinical Oncology
🌎 Country: Norway
ㅤContext to the study:
What is the most important prognostic factor for risk of relapse in nonseminomatous germ-cell testicular cancer (NSGCT)?
ㅤ✅ Take-home message of study:
Lympho-vascular invasion is the most important prognostic factor for risk of relapse in nonseminomatous germ-cell testicular cancer (NSGCT).
The aim of this study was to offer risk-adapted adjuvant treatment with BEP to patients with clinical stage 1 NSGCT to reduce the risk of relapse. Patients were divided into vascular invasion positive (VASC+) and vascular invasion negative (VASC-) groups.
VASC+ patients were recommended short-term adjuvant chemotherapy and could choose between one or two courses of bleomycin, etoposide, and cisplatin (BEP), while VASC- patients could choose between surveillance and one course of BEP.
One course of adjuvant BEP reduces the risk of relapse by 90% in both VASC+ and
VASC- clinical stage 1 NSGCT
ㅤ Prospective, community-based multicentre study by Swedish and Norwegian Testicular Cancer Project (SWENOTECA) management program
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Study participants:
745 clinical stage 1 NSGCT patients
26 centers in Sweden and Norway, between 1997-2005
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Key study outcomes:
The median follow-up time was 4.7 years
VASC- patients:
13.2% of patients on surveillance relapsed
1.3% of patients relapsed after 1 course of BEP
Recommendation: both surveillance and one course of BEP are options for VASC- clinical stage 1 NSGCT
VASC+ patients:
41.7% of patients on surveillance relapsed
3.2% of patients relapsed after 1 course of BEP
Recommendation: one course of BEP as standard treatment of VASC+ clinical stage 1 NSGCT
The toxicity of adjuvant BEP was low
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Study Limitations:
Non-randomised trial
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