Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer
✍ Scribed by Giorgio Pizzocaro; Roberto Salvioni; Massimo Pasi; Fulvio Zanoni; Angelo Milani; Silvana Pilotti; Silvio Monfardini
- Publisher
- John Wiley and Sons
- Year
- 1985
- Tongue
- English
- Weight
- 630 KB
- Volume
- 56
- Category
- Article
- ISSN
- 0008-543X
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✦ Synopsis
Sixty consecutive patients with Stage I11 or bulky Stage II nonseminatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of >3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits < 5 cm and/or lymph node metastases < 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.
Cancer 56249-255, 1985.
ISPLATIN, vinblastine, bleomycin combination che-C motherapy (PVB) is a milestone in the management of disseminated testicular cancer.' Approximately two thirds of patients enter complete remission (CR) after either the 0.4 or 0.3 mg/kg vinblastine and an additional 11% of patients can be made tumor free by surgical removal of the residual tumor.I4 After four inductions, no more than 10% of complete responders experience relapse, and maintenance therapy is not ne~essary.~,~