Journal of Clinical Oncology, Vol 10, 564-568, Copyright © 1992 by American Society of Clinical Oncology
Surveillance after orchidectomy for patients with clinical stage I nonseminomatous testis tumors
JF Sturgeon, MA Jewett, RE Alison, MK Gospodarowicz, R Blend, S Herman, H Richmond, G Thomas, W Duncan and A Munro
Department of Medicine, Princess Margaret Hospital, Toronto, Ontario, Canada.
PURPOSE: This study was designed to determine the proportion of patients
with clinical stage I nonseminomatous germ cell tumors of the testis
(NSGCTT) managed with surveillance after orchidectomy who have more
advanced disease and, therefore, require further treatment, the time to
progression, the sites of progression, and the efficacy of treatment
delayed until progression was recognized. PATIENTS AND METHODS: One hundred
five patients were observed prospectively without further treatment after
orchidectomy and full clinical staging. Treatment was given immediately
upon detection of marker-positive, clinical, or radiologic evidence of
disease. RESULTS: Thirty-seven patients (35.2%) have required further
therapy for disease progression, occurring from 2 to 21 months after
diagnosis. Thirty-six patients have been successfully treated. Overall, 104
patients (99%) remain alive and free of disease at 12 to 121 months after
orchidectomy. Progression occurred in the retroperitoneum in 25 of 37
patients who developed further disease on surveillance. The presence of
vascular invasion in the primary tumor was predictive of an increased risk
of progression. CONCLUSION: Surveillance is a valid alternative to
immediate retroperitoneal lymph node dissection in patients with clinical
stage I NSGCTT but should be recommended only under the close supervision
of physicians experienced in the diagnosis and treatment of testicular
cancer.
