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Single-course bleomycin, etoposide, and cisplatin (1xBEP) as adjuvant treatment in testicular nonseminoma clinical stage 1: outcome, safety, and risk factors for relapse in a population-based study
KP. Dieckmann, T. Pokrivcak, L. Geczi, D. Niehaus, I. Dralle-Filiz, C. Matthies, T. Dienes, S. Zschäbitz, P. Paffenholz, T. Gschliesser, R. Pichler, M. Mego, P. Bader, F. Zengerling, J. Heinzelbecker, P. Krausewitz, S. Krege, G. Aurilio, C....
Language English Country Great Britain
Document type Journal Article
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- Journal Article MeSH
Introduction: Clinical stage 1 (CS1) nonseminomatous (NS) germ cell tumors involve a 30% probability of relapse upon surveillance. Adjuvant chemotherapy with one course of bleomycin, etoposide, and cisplatin (1xBEP) can reduce this risk to <5%. However, 1xBEP results are based solely on five controlled trials from high-volume centers. We analyzed the outcome in a real-life population. Patients and Methods: In a multicentric international study, 423 NS CS1 patients receiving 1xBEP were retrospectively evaluated. Median follow-up was 37 (range, 6-89) months. Primary end points were relapse-free and overall survival evaluated after 5 years. We also looked at associations of relapse with clinico-pathological factors using stratified Kaplan-Meier methods and Cox regression models. Treatment modality and outcome of recurrences were analyzed descriptively. Results: The 5-year relapse-free survival rate was 96.2%. Thirteen patients (3.1%; 95% confidence interval, 1.65-5.04%) relapsed after a median time of 13 months, of which 10 were salvaged (77%). Relapses were mostly confined to retroperitoneal nodes. Three patients succumbed, two to disease progression and one to toxicity of chemotherapy. Pathological stage >pT2 was significantly associated with relapse rate. Conclusion: The relapse rate of 3.1% found in this population of NS CS1 patients treated with 1xBEP at the routine care level was not inferior to the median rate of 2.3% reported from a meta-analysis of controlled trials. Also, the cure rate of relapses of 77% is consistent with the previously reported rate of 80%. This study clearly shows that the 1xBEP regimen represents a safe treatment for NS CS1 patients.
2nd Department of Oncology Faculty of Medicine Comenius University Bratislava Slovak Republic
Department of Hematology and Oncology Red Cross Hospital Munich Germany
Department of Medical Oncology Universitätsklinikum Heidelberg Heidelberg Germany
Department of Medical Oncology Wilhelminenspital Vienna Austria
Department of Oncology Charles University and Thomayer Hospital Prague Czech Republic
Department of Urology Albertinen Krankenhaus Hamburg Germany
Department of Urology and Andrology Paracelsus Medical University Salzburg Salzburg Austria
Department of Urology and Pediatric Urology Universitätsklinikum Bonn Bonn Germany
Department of Urology Asklepios Klinik Altona Hamburg Germany
Department of Urology Bundeswehrkrankenhaus Hamburg Hamburg Germany
Department of Urology Bundeswehrkrankenhaus Ulm Ulm Germany
Department of Urology Bundeswehrzentralkrankenhaus Koblenz Koblenz Germany
Department of Urology Central Hospital Bolzano Bolzano Italy
Department of Urology Evangelische Kliniken Essen Mitte Essen Germany
Department of Urology Heinrich Heine University Düsseldorf Düsseldorf Germany
Department of Urology Klinikum Klagenfurt Klagenfurt Austria
Department of Urology Medical University of Innsbruck Innsbruck Austria
Department of Urology Städtisches Klinikum Karlsruhe Karlsruhe Germany
Department of Urology Universitätsklinikum Halle Germany
Department of Urology Universitätsklinikum Schleswig Holstein Lübeck Germany
Department of Urology Universitätsklinikum Ulm Ulm Germany
Division of Oncology Medical University of Graz Graz Austria
Martini Klinik University Medical Center Hamburg Eppendorf Hamburg Germany
References provided by Crossref.org
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