Clinical stage B non-seminomatous germ cell testis cancer: The Indiana University experience (1965-1989) using routine primary retroperitoneal lymph node dissection

J. P. Donohue, J. A. Thornhill, Richard Foster, R. G. Rowland, Richard Bihrle

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Abstract

Between 1965 and 1989, 1180 patients at Indiana University, U.S.A., underwent retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ cell (NSGC) testis cancer of whom 638 cases had primary RPLND. A subset of 174 cases were considered clinical stage B (or II) before surgery (retroperitoneal nodal metastases by clinical staging). Surgery revealed that 23% (n = 41) had pathological stage A disease (no cancerous nodes). This error rate in clinical staging has decreased somewhat with improved techniques, but remains approximately 20% over the last decade. The relapse rate in pathological stage A (n = 41) was 5% (n = 2), both of whom were cured by chemotherapy. The relapse rate in pathological stage B without postoperative adjuvant treatment (n = 54) was 35% (n = 19); 2 patients died. This indicates that 65% of pathological stage B cases were cured by RPLND alone. From 1979 to 1989, the 140 pathological stage B cases participated in a randomised prospective trial of post-RPLND adjuvant chemotherapy versus no postoperative treatment. Forty two per cent (n = 59) received postoperative platinum-based therapy (two cycles), and there has been no relapse after RPLND for stage B disease. While advances in chemotherapy for NSGC testis cancer have led to its application by several study groups to clinical stage B (or II) testis cancer (with surgery reserved only for those in partial remission), the equivalent cure rate with RPLND surgery with chemotherapy rescue reserved for those who relapse appears to have both cost and risk-benefit advantages.

Original languageEnglish
Pages (from-to)1599-1604
Number of pages6
JournalEuropean Journal of Cancer
Volume31
Issue number10
DOIs
StatePublished - 1995

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Germ Cell and Embryonal Neoplasms
Testicular Neoplasms
Lymph Node Excision
Recurrence
Drug Therapy
Adjuvant Chemotherapy
Platinum
Cost-Benefit Analysis
Therapeutics
Neoplasm Metastasis

Keywords

  • clinical stage B testis cancer
  • comparison to primary chemotherapy
  • retroperitoneal lymph node dissection

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Hematology

Cite this

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title = "Clinical stage B non-seminomatous germ cell testis cancer: The Indiana University experience (1965-1989) using routine primary retroperitoneal lymph node dissection",
abstract = "Between 1965 and 1989, 1180 patients at Indiana University, U.S.A., underwent retroperitoneal lymph node dissection (RPLND) for non-seminomatous germ cell (NSGC) testis cancer of whom 638 cases had primary RPLND. A subset of 174 cases were considered clinical stage B (or II) before surgery (retroperitoneal nodal metastases by clinical staging). Surgery revealed that 23{\%} (n = 41) had pathological stage A disease (no cancerous nodes). This error rate in clinical staging has decreased somewhat with improved techniques, but remains approximately 20{\%} over the last decade. The relapse rate in pathological stage A (n = 41) was 5{\%} (n = 2), both of whom were cured by chemotherapy. The relapse rate in pathological stage B without postoperative adjuvant treatment (n = 54) was 35{\%} (n = 19); 2 patients died. This indicates that 65{\%} of pathological stage B cases were cured by RPLND alone. From 1979 to 1989, the 140 pathological stage B cases participated in a randomised prospective trial of post-RPLND adjuvant chemotherapy versus no postoperative treatment. Forty two per cent (n = 59) received postoperative platinum-based therapy (two cycles), and there has been no relapse after RPLND for stage B disease. While advances in chemotherapy for NSGC testis cancer have led to its application by several study groups to clinical stage B (or II) testis cancer (with surgery reserved only for those in partial remission), the equivalent cure rate with RPLND surgery with chemotherapy rescue reserved for those who relapse appears to have both cost and risk-benefit advantages.",
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AU - Foster, Richard

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AU - Bihrle, Richard

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