Pilot study to evaluate impact of a policy of adjuvant chemotherapy for high risk stage 1 malignant teratoma on overall relapse rate of stage 1 cancer patients

Secondary tumours following etoposide containing therapy for germ cell cancer

BACKGROUND

Reports have implied etoposide as the cause of secondary leukaemia in patients treated for germ cell cancer.

PATIENTS AND METHODS

Between 1979 and 1992, 679 male patients with germ cell cancer received etoposide containing chemotherapy.

RESULTS

Six of 679 patients developed acute myeloid leukaemia (relative risk 150; CI: 55-326). None of these patients had a primary mediastinal germ cell tumour and only 1 patient received previous radiotherapy. The median interval between the onset of cytotoxic treatment and the development of leukaemia was 27 months. The FAB M4 morphology was seen in 4 of 6 cases.

CONCLUSION

The benefit of etoposide containing protocols outweigh the risk of leukaemia in patients with intermediate or high risk disease, however in patients with good risk disease non-etoposide containing protocols should be explored.

Laparoscopic retroperitoneal lymphadenectomy for high-risk stage 1 nonseminomatous germ cell tumor: report of four cases

OBJECTIVE

To evaluate in a prospective fashion the feasibility of performing retroperitoneal lymphadenectomy (RPL) for high-risk Stage 1 nonseminomatous germ cell tumors (NSGCT) using a laparoscopic technique, and to compare the results to historical controls.

METHODS

RPL was performed laparoscopically on patients with Stage 1 NSGCT: Each patient had pathologic risk factors associated with an increased likelihood of metastases, and radiologic investigations revealed no evidence of retroperitoneal or distant disease. A modified template lymphadenectomy was performed in each case. The results of these four operations were compared to eight open RPLs performed on a similar group of patients.

RESULTS

In 3 of the 4 cases, a thorough dissection was possible. In 1 of these 3, an open laparotomy was required to repair a caval laceration resulting from avulsion of a small lumbar vein at the end of the laparoscopic dissection. Compared to the open approach, there was considerably less postoperative morbidity.

CONCLUSIONS

This procedure may represent an alternative approach to surveillance or open RPL for high-risk Stage 1 patients. Further experience is required to determine the sensitivity and effectiveness of this procedure compared to open RPL before its role in clinical practice can be established.

Retroperitoneal lymphadenectomy for clinical stage A testis cancer (1965 to 1989): modifications of technique and impact on ejaculation

Results with primary retroperitoneal lymphadenectomy in 464 patients with clinical stage A nonseminomatous germ cell testis cancer (1965 to 1989) were reviewed. The false-negative staging error by clinical methods remains at 30%. The relapse rate in pathological stage A cancer patients was 11% (37 of 323), with 2 deaths. For pathological stage B disease 64% of the patients were cured by retroperitoneal lymphadenectomy alone. With modern adjuvant chemotherapy no stage B tumor relapsed since 1979 and the survival rate was 100%. For all 25 years (464 patients) the relapse rate was 14% and the survival rate was 98.9% (3 cancer and 2 noncancer deaths). Because these results are based on preoperative clinical staging, they are directly comparable with series using radiotherapy or surveillance.