Radiation Medicine Program, Princess Margaret Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
BJU Int. 2013 Dec;112(8):1088-95. doi: 10.1111/bju.12330. Epub 2013 Aug 13.
To examine the management and outcomes of patients with stage I seminoma and to relate these to overall treatment burden.
A total of 764 patients with stage I seminoma underwent surveillance or adjuvant radiation therapy (RT) at a single institution. First relapse on surveillance was managed with RT alone, or with combination chemotherapy (ChT) for more extensive recurrence. Second relapse was managed with ChT. Relapse after adjuvant RT was treated with ChT. The treatment burden was measured, according to the specific treatment undertaken after orchiectomy, by defining treatment episodes as follows: surgery - one episode; one course of RT - one episode; one course of ChT - one episode.
In all, 484 patients underwent surveillance and 280 received adjuvant RT. The 5- and 10-year overall survival rates were 98.6 and 97.7% for surveillance, and 97.2 and 91.4% for adjuvant RT. A total of 72 (15%) patients in the surveillance group relapsed; treatment for relapse was RT (n = 56), ChT (n = 15) and surgery (n = 1). Second relapse occurred in six patients; these patients were treated with ChT. Of the patients in the adjuvant RT group, 14 (5%) relapsed: salvage treatment was 10 - ChT (n = 10) surgery (n = 1) and further RT (n = 3). The overall treatment burden represented by number of treatment episodes per patient was 0.16 in the surveillance group and 1.05 in the adjuvant RT group.
Surveillance reduces the overall treatment burden in patients with stage I seminoma and is the preferred management option. The selective use of RT at first relapse for patients on surveillance leads to a similar requirement for subsequent ChT to that for patients on adjuvant RT.
研究Ⅰ期精原细胞瘤患者的治疗管理和结局，并将其与总体治疗负担联系起来。
共有 764 例Ⅰ期精原细胞瘤患者在一家医疗机构接受监测或辅助放疗（RT）。在监测时首次复发，单独采用 RT 治疗，或对更广泛的复发采用联合化疗（ChT）。对于辅助 RT 后复发，采用 ChT 治疗。根据睾丸切除术后的具体治疗方法，将治疗负担定义为以下方式进行衡量：手术-一个疗程；一次 RT 治疗-一个疗程；一次 ChT 治疗-一个疗程。
总共 484 例患者接受监测，280 例患者接受辅助 RT。监测组的 5 年和 10 年总生存率分别为 98.6%和 97.7%，辅助 RT 组的 5 年和 10 年总生存率分别为 97.2%和 91.4%。监测组中有 72 例（15%）患者复发；治疗复发采用 RT（n = 56）、ChT（n = 15）和手术（n = 1）。6 例患者出现第二次复发，采用 ChT 治疗。辅助 RT 组中有 14 例（5%）患者复发：挽救治疗为 10 例 ChT（n = 10）、手术（n = 1）和进一步 RT（n = 3）。每个患者的治疗次数代表的总体治疗负担在监测组中为 0.16，在辅助 RT 组中为 1.05。
监测可降低Ⅰ期精原细胞瘤患者的总体治疗负担，是首选的治疗方法。对监测患者首次复发时选择性采用 RT，后续 ChT 的需求与辅助 RT 患者相似。
