Oliver R T, Edmonds P M, Ong J Y, Ostrowski M J, Jackson A W, Baille-Johnson H, Williams M V, Wiltshire C R, Mott T, Pratt W R
Dept. of Medical Oncology, Royal London Hospital, England.
Int J Radiat Oncol Biol Phys. 1994 Apr 30;29(1):3-8. doi: 10.1016/0360-3016(94)90219-4.
Underpinned by increased confidence in cure of metastatic seminoma by chemotherapy during the past 12 years, three management strategies for Stage I seminoma have been evaluated by six collaborating centers within the Anglian Germ Cell Tumor Group. This paper evaluates the efficacy of surveillance, prophylactic radiotherapy and adjuvant chemotherapy, and discusses these differing management approaches.
Patients were recruited into the study between 1982 and 1992. There was no randomization between treatment groups. Seventy-nine patients received prophylactic radiotherapy (median follow-up = 51 months), 67 patients had surveillance alone (median follow-up = 61 months) and 78 patients were treated with adjuvant single agent platinum (median follow-up = 44 months). Fifty-three of these patients received two courses of platinum (median follow-up = 51 months) and 25 patients received one course (median follow-up = 29 months, range 22-72 months).
There were 18 (27%) recurrences on surveillance, five (6%) after radiotherapy, one (1%) after two courses of adjuvant single agent platinum and none after one course of carboplatin. There was one death from testis cancer after radiotherapy and none after adjuvant chemotherapy treatments. Two patients died with drug resistant disease after relapse on surveillance. There was one death from a myocardial infarction after prophylactic radiotherapy and one death from suicide in the surveillance group. A retrospective quality of life questionnaire reviewing the incidence of early and late toxicity revealed no major differences though they suggest that those treated with one course adjuvant carboplatin had somewhat less sickness and an earlier return to work.
Single agent carboplatin appears well tolerated and is an effective adjuvant treatment for Stage I seminoma. A multicenter randomized trial of the different treatment modalities is required to further evaluate its use.
在过去12年对转移性精原细胞瘤化疗治愈信心增强的背景下，东安格利亚生殖细胞肿瘤组的六个合作中心对I期精原细胞瘤的三种管理策略进行了评估。本文评估了监测、预防性放疗和辅助化疗的疗效，并讨论了这些不同的管理方法。
1982年至1992年期间招募患者进入该研究。治疗组之间未进行随机分组。79例患者接受预防性放疗（中位随访时间 = 51个月），67例患者仅接受监测（中位随访时间 = 61个月），78例患者接受辅助单药铂类治疗（中位随访时间 = 44个月）。其中53例患者接受了两个疗程的铂类治疗（中位随访时间 = 51个月），25例患者接受了一个疗程（中位随访时间 = 29个月，范围22 - 72个月）。
监测中有18例（27%）复发，放疗后5例（6%）复发，两个疗程辅助单药铂类治疗后1例（1%）复发，一个疗程卡铂治疗后无复发。放疗后有1例死于睾丸癌，辅助化疗治疗后无死亡病例。2例患者在监测复发后死于耐药疾病。预防性放疗后有1例死于心肌梗死，监测组有1例死于自杀。一项回顾早期和晚期毒性发生率的生活质量问卷显示，虽无重大差异，但提示接受一个疗程辅助卡铂治疗的患者恶心症状较轻，恢复工作较早。
单药卡铂耐受性良好，是I期精原细胞瘤的有效辅助治疗方法。需要进行一项多中心随机试验以进一步评估其应用。
