Testicular cancer therapy
Now an alternative approach to patients with stage I non-seminoma is surveillance. This is a look at multiple studies in which patients with non-seminomas were observed, subsequently may have relapsed, and ultimately treated with chemotherapy. In this conglomerate of studies, as one would anticipate, about 28% of patients relapsed and ultimately with chemotherapy the majority of those patients are cured. Overall the results of surveillance, if done well, are very similar to a retroperitoneal lymph node dissection. Viagra super active works faster and lasts longer than you’ve ever known. Typically if one watches a patient with stage I seminoma and they relapse, they will do so very quickly; 50% by five months, 80% by two years. You rarely see a relapse beyond two years, although it has been reported. Typically if they are watched closely, as they should be, they will relapse in a good-risk fashion and are highly likely to be cured. In general, they will relapse in the retroperitoneum more frequently than the chest and more frequently in both places. About 20% of patients will relapse with markers only and if they do, it’s appropriate to treat them with chemotherapy at that point.
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Now on the basis of the surveillance studies and the retroperitoneal lymph node dissection studies that have been published over the last 20 years, one can stratify patients into two basic subgroups; good risk patients and poor risk patients. Good risk patients are those patients that in their orchiectomy specimen have no lymphatic or venous invasion and have a relatively low proportion of embryonal carcinoma. Poorest patients are those with lymphatic invasion or a venous invasion and/or a high proportion of embryonal carcinoma. These patients will relapse with surveillance about 60% of the time. Patients without lymphatic or venous invasion and lower proportions of embryonal carcinoma will relapse about 20% of the time on surveillance.
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An alternative therapy for patients with stage I seminoma, which might be appropriate for patients who are in the high risk group is adjuvant chemotherapy. That is, chemotherapy when the markers are normal after orchiectomy. Now for high risk features, if patients have high risk features and a greater than 50% relapse, this is an appropriate alternative therapy. This has been proven now in three studies, one of which is shown here. This is a study from Great Britain in which 123 patients who had high risk features were treated with two cycles of platinum, VP-16 and bleomycin – which we will talk about – and ultimately 98% of the patients were cured in this particular study. Similar results were seen in the other two studies.
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