Patterson H, Norman A R, Mitra S S, Nicholls J, Fisher C, Dearnaley D P, Horwich A, Mason M D, Huddart R A
Academic Radiotherapy Unit, Institute of Cancer Research and The Royal Marsden NHS Trust, 15 Cotswold Road, Belmont, Sutton, SM2 5NG, Surrey, UK.
Radiother Oncol. 2001 Apr;59(1):5-11. doi: 10.1016/s0167-8140(00)00240-1.
To assess the results of treatment in 33 patients with stage IIA/B seminoma who were treated with carboplatin and radiotherapy (RT) between January 1989 and December 1996.
Thirty patients received single course single agent carboplatin (400 mg/m2 or area under curve (AUC 7), two patients received two courses carboplatin, and one patient received single course carboplatin and etoposide, all 4-6 weeks prior to infra-diaphragmatic RT. Results were retrospectively compared with those obtained for 80 patients treated from 1970 to 1998 with radiotherapy alone.
There was minimal toxicity associated with the use of carboplatin prior to RT. With a median follow-up of 4 years (range 2-70 months) 2/33 patients treated with chemotherapy and RT have relapsed, 5-year relapse free survival (RFS) = 96.9% (95% confidence interval (CI) 72.9-99.4%), and one patient has died of progressive disease, 5-year overall survival (OS) = 96.7%. With a median follow-up of 11.2 years (range 6 months to 25.8 years) 15/80 patients treated with RT alone have relapsed, 5-year RFS = 80.7% (95% CI 70.1-87.9%), including 13/61 patients treated with infra-diaphragmatic RT, 5-year RFS = 77.9%, and 2/19 treated with additional supra-diaphragmatic RT, 5-year RFS = 89.5% (P = 0.277). Eleven out of 80 patients have died, 5-year OS = 94.7%. For stage IIA, 1/14 patients treated with chemotherapy and RT have relapsed, 5-year RFS = 92.3%, compared with 5/34 treated with infra-diaphragmatic RT alone 5-year, RFS = 84.9% (P = 0.527). For stage IIB, 1/19 patients relapsed (at 69 months) following chemotherapy and RT (5-year RFS = 100%), whereas 8/27 relapsed following infra-diaphragmatic RT alone, 5-year RFS = 69.4% (P = 0.0595).
Infradiaphragmatic RT alone cures the majority of patients with stage II seminoma, but the relapse rate remains high particularly for patients with stage IIB disease. As compared with historical controls, carboplatin with RT appears to reduce the relapse rate in stage II seminoma with minimal additional toxicity and the results approach statistical significance for stage IIB patients. Confirmation would require a phase III randomized comparison.
评估1989年1月至1996年12月期间接受卡铂和放疗（RT）治疗的33例IIA/B期精原细胞瘤患者的治疗结果。
30例患者接受单疗程单药卡铂（400mg/m²或曲线下面积（AUC 7）），2例患者接受两疗程卡铂，1例患者接受单疗程卡铂和依托泊苷，均在膈下放疗前4 - 6周进行。结果与1970年至1998年期间仅接受放疗的80例患者进行回顾性比较。
放疗前使用卡铂的毒性极小。中位随访4年（范围2 - 70个月），接受化疗和放疗的33例患者中有2例复发，5年无复发生存率（RFS）= 96.9%（95%置信区间（CI）72.9 - 99.4%），1例患者死于疾病进展，5年总生存率（OS）= 96.7%。中位随访11.2年（范围6个月至25.8年），仅接受放疗的80例患者中有15例复发，5年RFS = 80.7%（95% CI 70.1 - 87.9%），其中61例接受膈下放疗的患者中有13例复发，5年RFS = 77.9%，19例接受额外膈上放疗的患者中有2例复发，5年RFS = 89.5%（P = 0.277）。80例患者中有11例死亡，5年OS = 94.7%。对于IIA期，接受化疗和放疗的14例患者中有1例复发，5年RFS = 92.3%，而仅接受膈下放疗的34例患者中有5例复发，5年RFS = 84.9%（P = 0.527）。对于IIB期，19例接受化疗和放疗的患者中有1例（在69个月时）复发（5年RFS = 100%），而仅接受膈下放疗的27例患者中有8例复发，5年RFS = 69.4%（P = 0.0595）。
单纯膈下放疗可治愈大多数II期精原细胞瘤患者，但复发率仍然较高，特别是对于IIB期疾病患者。与历史对照相比，卡铂联合放疗似乎可降低II期精原细胞瘤的复发率，且额外毒性极小，对于IIB期患者，结果接近统计学显著性差异。需要进行III期随机对照试验来证实。
