ROBERT J. MOTZER, M.D.; GEORGE J. BOSL, M.D.; NANCY L. GELLER, Ph.D.; DARRYL PENENBERG, M.A.; ALAN YAGODA, M.D.; ROBERT GOLBEY, M.D.; WILLET F. WHITMORE Jr., M.D.; WILLIAM R. FAIR, M.D.; PRAMOD SOGANI, M.D.; HARRY HERR, M.D.; MICHAEL MORSE, M.D.; ROBERT W. CAREY, M.D.; NICHOLAS VOGELZANG, M.D.
Study Objective: To determine the effectiveness of chemotherapy and adjunctive surgery in managing patients with advanced seminoma.
Design: Nonrandomized prospective clinical trial of chemotherapy in a cohort of patients with advanced seminoma.
Setting: Referral cancer hospital.
Patients: Consecutive sample of 62 patients with primary extragonadal, stage IIC (> 5-cm retroperitoneal adenopathy) and stage III seminoma; 45 patients were previously untreated, 13 had received radiotherapy, and 4 had previously received radiotherapy and chemotherapy.
Intervention: Cisplatin-based chemotherapy (100 to 120 mg/m2 body surface area per cycle of treatment); 45 patients received vinblastine, bleomycin, cisplatin, dactinomycin, and cyclophosphamide; 15, etoposide and cisplatin; and 2, both regimens.
Measurements and Main Results: Fifty-three of the sixty (88%) evaluable patients achieved a complete remission, and only 6 patients had relapses. Fifty-three of the sixty-two patients (85%) remain alive and disease-free. The regimen of etoposide and cisplatin was equivalent to regimens using more drugs. An elevated level of human chorionic gonadotropin at the initiation of treatment was associated with a worse prognosis.
Conclusions: Cisplatin-based chemotherapy is effective treatment for patients with extragonadal, stage IIC, and stage III seminoma and should be considered as initial therapy.
MOTZER RJ, BOSL GJ, GELLER NL, et al. Advanced Seminoma: The Role of Chemotherapy and Adjunctive Surgery. Ann Intern Med. 1988;108:513–518. doi: 10.7326/0003-4819-108-4-513
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Published: Ann Intern Med. 1988;108(4):513-518.
Hematology/Oncology, Hospital Medicine.
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