Motzer R J, Sheinfeld J, Mazumdar M, Bajorin D F, Bosl G J, Herr H, Lyn P, Vlamis V
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Clin Oncol. 1995 Nov;13(11):2700-4. doi: 10.1200/JCO.1995.13.11.2700.
Two options cure nearly all patients with pathologic stage II nonseminomatous germ cell tumors (NSGCTs): two cycles of adjuvant chemotherapy with cisplatin, vinblastine, and bleomycin (PVB) or cisplatin, vinblastine, bleomycin, cyclophosphamide, and dactinomycin (VAB-6); or close observation with full treatment at relapse. Two cycles of etoposide plus cisplatin (EP) were given to selected patients with pathologic stage II NSGCT and high-volume nodal metastases.
All patients had pathologic stage II NSGCT with one or more of the following features found at retroperitoneal lymph node dissection (RPLND), suggesting a greater than 50% likelihood of relapse after observation alone: (1) any lymph node involved by tumor greater than 2 cm (stage N2b); (2) > or = six nodes involved with tumor (stage N2b); and (3) extranodal extension (stage N3). Two cycles of therapy were given at 21-day intervals; each cycle consisted of etoposide 100 mg/m2 plus cisplatin 20 mg/m2 per day given on days 1 to 5.
Fifty patients were treated with two cycles of EP. Treatment was well tolerated; five patients (10%) were admitted for nadir fever and none had grade II or greater neurologic, renal, or pulmonary toxicity. All 50 patients are alive and relapse-free at a median follow-up time of 35 months (range, 12 to 72). The follow-up duration has been > or = 2 years for 42 patients.
A treatment program that consists of two cycles of EP is effective in preventing relapses in patients with completely resected pathologic stage N2b and N3 NSGCT. The likelihood of relapse without adjuvant cisplatin-containing chemotherapy in this group has been shown to be greater than 50%. As has been demonstrated in patients with disseminated germ cell tumor (GCT), EP can be considered a therapeutic option in the adjuvant setting for completely resected N2b and N3 NSGCT.
有两种方案可治愈几乎所有病理分期为II期的非精原细胞性生殖细胞肿瘤（NSGCT）患者：顺铂、长春花碱和博来霉素（PVB）或顺铂、长春花碱、博来霉素、环磷酰胺和放线菌素（VAB - 6）进行两个周期的辅助化疗；或密切观察，复发时进行全面治疗。对选定的病理分期为II期且有大量淋巴结转移的NSGCT患者给予两个周期的依托泊苷加顺铂（EP）治疗。
所有患者均为病理分期为II期的NSGCT，在腹膜后淋巴结清扫术（RPLND）中发现具有以下一项或多项特征，提示单纯观察后复发可能性大于50%：（1）任何被肿瘤累及的淋巴结大于2 cm（N2b期）；（2）≥6个淋巴结被肿瘤累及（N2b期）；（3）结外扩展（N3期）。每21天进行两个周期的治疗；每个周期包括依托泊苷100 mg/m²加顺铂20 mg/m²，每天给药，持续1至5天。
50例患者接受了两个周期的EP治疗。治疗耐受性良好；5例患者（10%）因最低点发热入院，无一例出现II级或更高级别的神经、肾脏或肺部毒性。所有50例患者均存活且无复发，中位随访时间为35个月（范围12至72个月）。42例患者的随访时间≥2年。
由两个周期EP组成的治疗方案可有效预防完全切除的病理分期为N2b和N3期的NSGCT患者复发。该组患者在不进行含顺铂辅助化疗的情况下复发可能性已被证明大于50%。正如在播散性生殖细胞肿瘤（GCT）患者中所证实的那样，EP可被视为完全切除的N2b和N3期NSGCT辅助治疗的一种选择。
