Primary chemotherapy for clinical stage II nonseminomatous germ cell XXXX : selection criteria and long-term results.

@entity1 @entity66 @entity5 @entity809 @entity900 @entity2879 @entity392 @entity74 @entity1732 @entity204
OBJECTIVE: To determine the treatment option for @entity1 with low-volume stage II nonseminomatous germ cell @entity5 (NSGCTT) that yields the best survival, is associated with the least morbidity, and avoids "double therapy"--that is, chemotherapy and retroperitoneal lymph node dissection (RPLND). DESIGN: We reviewed our institutional experience with 28 @entity1 with stage II NSGCTT who received primary chemotherapy between August 1983 and October 1992. MATERIAL AND METHODS: The 28 study @entity1 (mean age, 28 years; range, 20 to 52) with low-volume stage II NSGCTT were treated with @entity1732 , @entity2879 , and @entity900 . The correlation of response rates with @entity66 and predominant histologic cell type was determined. The duration of survival was measured from the initiation of chemotherapy to the appearance of @entity74 or @entity204 or the date of last follow-up visit. RESULTS: Of the 28 @entity1 treated, 27 (96%) achieved a complete response--20 (71%) with only chemotherapy and an additional 7 (25%) with chemotherapy plus surgical treatment. Twenty-seven @entity1 (96%) remained free of disease after a median follow-up of 72 months. The most frequent complication was @entity900 -associated @entity809 or @entity392 which was noted in 13 @entity1 (46%). In 11 of 15 @entity1 (73%), attempts to have @entity1 have been successful. CONCLUSION: Excellent long-term survival rates in @entity1 with stage II NSGCTT can be achieved with primary chemotherapy. In this series, 71% of @entity1 were spared RPLND. The need for postchemotherapy RPLND seemed to be related to the initial metastatic @entity5 volume and possibly the histologic features of the @entity5 . Continued refinement in surgical techniques and chemotherapeutic regimens will necessitate the comparison of these two treatment approaches in a randomized prospective trial.
