Kennedy B J, Torkelson J, Fraley E E
Department of Medicine, University of Minnesota Medical School, University Hospital, Minneapolis 55455, USA.
Am J Clin Oncol. 1995 Dec;18(6):463-8. doi: 10.1097/00000421-199512000-00001.
Nonseminomatous germ cell tumors (NSGCT) (testicular carcinoma) are a curable disease. Stages I and II are nearly 100% curable. Stage III has had remarkable progress in attaining complete regression, but a substantial number fail to be cured. Using platinum-based regimens such as vinblastine, bleomycin, and cisplatin (VBP), or using etoposide instead of vinblastine (BEP), or without bleomycin (EP), four courses of chemotherapy have become a national standard. Based on our prior experience with mithramycin (plicamycin), which used six courses, six courses of VBP chemotherapy were utilized as our treatment goal. This report challenges the concept that "standard therapy" for stage III testicular carcinoma is four courses.
From 1976 to 1990, 74 patients with advanced NSGCT were treated with standard doses of plantinum-based chemotherapies. Five or more courses were delivered to 41 patients and fewer than five courses to 33 patients. The intent of therapy was to attain as close to six courses as possible. Because of physician preference, patient adherence, or toxicity, some patients did not reach that goal.
Of 33 patients receiving less than five courses, there were 28 (85%) complete responders, and 26 (78.8%) are alive. Of 41 patients receiving five or more courses, 38 (92.7%) had complete responses, and 34 (83%) are alive. One person in each group is living with nonresectable teratoma present. In the group receiving 5+ courses, two died from causes unrelated to testis cancer and had no testis cancer present. As a result of the initial treatment, there was no evidence of cancer in 24 (72.8%) in the group receiving less than five courses and 35 (85.4%) had no cancer after five or more courses. In considering only patients with advanced level of stage III disease in contrast to minimal or moderate stage III disease, there were fewer complete regressions with less than five courses (64.3%) than with five or more courses (88.0%).
For minimal stage III disease, four courses of chemotherapy may be adequate. For advanced stage III disease, more chemotherapy provides fewer treatment failures. Once a complete response is achieved without restriction to an arbitrary number of courses, two additional courses may constitute a more curative regimen.
非精原细胞性生殖细胞肿瘤（NSGCT）（睾丸癌）是一种可治愈的疾病。I期和II期几乎100%可治愈。III期在实现完全缓解方面取得了显著进展，但仍有相当一部分患者未能治愈。使用基于铂的化疗方案，如长春花碱、博来霉素和顺铂（VBP），或用依托泊苷代替长春花碱（BEP），或不使用博来霉素（EP），四个疗程的化疗已成为国家标准。基于我们之前使用放线菌素D（普卡霉素）六个疗程的经验，六个疗程的VBP化疗被用作我们的治疗目标。本报告对III期睾丸癌“标准治疗”为四个疗程这一概念提出了挑战。
1976年至1990年，74例晚期NSGCT患者接受了标准剂量的基于铂的化疗。41例患者接受了五个或更多疗程，33例患者接受的疗程少于五个。治疗的目的是尽可能接近六个疗程。由于医生的偏好、患者的依从性或毒性，一些患者未达到该目标。
在接受少于五个疗程的33例患者中，有28例（85%）完全缓解，26例（78.8%）存活。在接受五个或更多疗程的41例患者中，38例（92.7%）完全缓解，34例（83%）存活。每组各有一人患有不可切除的畸胎瘤且存活。在接受5个及以上疗程的组中，有两人死于与睾丸癌无关的原因，且当时不存在睾丸癌。初始治疗后，接受少于五个疗程的组中有24例（72.8%）无癌症证据，接受五个或更多疗程后有35例（85.4%）无癌症。仅考虑III期疾病晚期的患者，与最小或中度III期疾病相比，接受少于五个疗程的完全缓解率（64.3%）低于接受五个或更多疗程的（88.0%）。
对于最小的III期疾病，四个疗程的化疗可能足够。对于晚期III期疾病，更多疗程的化疗治疗失败更少。一旦实现完全缓解，不受任意疗程数量的限制，额外的两个疗程可能构成更具治愈性的方案。
