Abstract
Since 1978 we have treated 132 patients with testicular cancer, 89 with nonseminomatous germ cell tumors (NST) and 43 with seminomas. In 22 of 37 NST we employed a “watch and wait” strategy (before 1983 in patients who refused therapy and from 1983 on, following informed consent). Twenty cases were followed; five patients relapsed (25%). In these patients we intiated a curative treatment protocol (PVB); all are in complete remission. After a median patient follow-up of 29 months we expect a cure rate of up to 100%. In 16 patients with stage II disease (no bulky disease) we found no vital tumor tissue during RLA after polychemotherapy. A single lymph node with a very small differentiated teratoma was found in each of two patients. Our experience is that about 75% of stage I NST patients may be cured by orchiectomy alone, thus avoiding the adverse effects of RLA, chemotherapy, or radiotherapy and the rest are still curable. A study should be initiated of patients with stage II nonbulky disease to find out if there is a subgroup which can be cured by chemotherapy alone.
Zusammenfassung
Seit 1978 wurden 132 Patienten mit Hodentumor behandelt, davon 89 mit nichtseminomatösem Tumor (NST) und 43 mit Seminom. 22 von 37 NST-Patienten wurden nach Semikastration nicht weiter behandelt, sondern nur beobachtet (“Watch and wait”), bis 1983 wegen Therapieverweigerung, ab 1983 nach Aufklärung und Zustimmung.
5 von 20 ausreichend lange beobachteten Patienten hatten ein Rezidiv (25%). Durch Behandlung mit PVB wurde in allen Fällen komplette Remission erzielt. Bei einer medianen Nachsorge von 29 Monaten ist die erwartete Heilungsrate annähernd 100%.
Bei keinem von 16 Stadium II-Patienten (ohne Bulky-Tumor) wurde bei RLA nach Polychemotherapie vitales Tumorgewebe gefunden, bei 2 Patienten fand sich in je einem Lymphknoten hochdifferenziertes, reifes Teratom. Nach unserer Erfahrung sind 75% der NST-Patienten im Stadium I mit der Orchiektomie geheilt, so daß nachteilige Effekte der RLA, der Chemotherapie oder der Strahlentherapie vermieden werden können. Die restlichen Patienten können durch Rezidivbehandlung mit Polychemotherapie geheilt werden. Im Stadim II (ohne Bulky-Tumor) sollte eine Studie durchgeführt werden, um Kriterien für eine alleinige Chemotherapie zu ermitteln.
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© 1988 Springer-Verlag Berlin Heidelberg
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Schäfer, E., Hoffmann, L. (1988). “Watch and wait” im Stadium I nichtseminomatöser Hodentumoren und “Watch and wait” im Stadium II nach Chemotherapie. In: Schmoll, HJ., Weißbach, L. (eds) Diagnostik und Therapie von Hodentumoren. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-73492-2_20
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DOI: https://doi.org/10.1007/978-3-642-73492-2_20
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