Therapeutic strategy in nonseminomatous cancer of the testis
Jacquillat, C.; Auclerc, G.; Verges, J.; Desprez-Curely, J.P.; Maral, J.
Annales de Medecine Interne 133(6): 416-420
1982
ISSN/ISBN: 0003-410X PMID: 7181244 Document Number: 196258
The prognosis of non-seminomatous carcinoma of the testis has been revolutionized by the introduction of chemotherapy for both advanced and localised forms of the disease. In the last 15 years, 41 cancers of this type (13 Stage I, 16 Stage II and 12 Stage III) have been treated in our Department. All Stage I cancers received postoperative chemotherapy comprising Velbé, Thiotepa, Rufocromomycine and Methotrexate and all are in remission with an average follow-up period of 8 years. Five Stage II had this protocol, the II others had 3 cycles of PVB (a pulmonary recurrence in one case was treated with 3 further cycles of PVB +/- Adriamycin) and curative surgery. This survival is 100 p. 100 with a follow-up ranging from I to II years. Six patients had post-chemotherapy surgery which was always negative. The combination used in Stage I was also used in 8 Stage III patients; there were 7 failures despite falling back on PVB in 4 cases; the 8th case in still is remission after years' follow-up. The PVB protocol was used recently in 4 other cases with 2 complete remissions, one death in remission during thoracotomy (shocking) and one death from aplasia after the first cycle. This gives a 24 p. 100 5 year survival but only a third of Stage III patients had PVB from the outset. A review of the literature and our own experience suggest that curage and chemotherapy are no longer indicated in Stage I; curage is only proposed after 3 cycles of PVB in Stage II cases with a poor prognosis; 4 to 6 cycles of PVB are recommended in Stage III with secondary surgery if indicated. Maintenance therapy does not seem to be necessary.