Motzer R J
Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, USA.
Semin Urol Oncol. 1996 Feb;14(1):30-3.
Two treatment options cure nearly all patients with pathological stage II testicular nonseminomatous germ cell tumor (NSGCT) following a retroperitoneal lymph node dissection (RPLND). These are (1) two cycles of adjuvant cisplatin-based chemotherapy and (2) close surveillance with chemotherapy reserved for patients who relapse. The decision to choose one of these options is dependent on the extent of tumor involvement at RPLND and patient compliance. Surveillance is the treatment of choice for compliant patients with minimal nodal involvement (<6 nodes involved, no node >2 cm, no extranodal extension; N(1), N(2a)) resected at RPLND; one third or less of these patients relapse to surveillance alone. Patients with "high volume" nodal involvement (<6 nodes involved, any node >2 cm; N(2b) or extranodal extension; N(3)) have a relapse rate of 50% to 90% to surveillance. The option of adjuvant chemotherapy in this group remains a strong consideration. A prospective trial of two cycles of etoposide plus cisplatin adjuvant chemotherapy for patients with pathological stage N(2b,3) showed that this regimen was highly effective and preferable to vinblastine-based regimens because it was better tolerated.
对于接受腹膜后淋巴结清扫术（RPLND）的病理II期睾丸非精原细胞瘤（NSGCT）患者，两种治疗方案几乎可治愈所有患者。这两种方案分别是：（1）基于顺铂的辅助化疗两个周期；（2）密切监测，仅对复发患者进行化疗。选择其中一种方案的决定取决于RPLND时肿瘤累及的范围以及患者的依从性。对于在RPLND时切除的淋巴结受累最少（<6个淋巴结受累，无淋巴结>2 cm，无结外扩展；N(1)，N(2a)）且依从性好的患者，监测是首选治疗方法；这些患者中三分之一或更少仅通过监测复发。“大量”淋巴结受累（<6个淋巴结受累，任何淋巴结>2 cm；N(2b)或结外扩展；N(3)）的患者接受监测的复发率为50%至90%。该组辅助化疗方案仍是一个重要的考虑因素。一项针对病理分期为N(2b,3)患者的依托泊苷加顺铂辅助化疗两个周期的前瞻性试验表明，该方案非常有效，且比基于长春碱的方案更可取，因为其耐受性更好。
