Radiotherapy after chemotherapy for metastatic seminoma - A diminishing role

被引:53
作者
Duchesne, GM
Stenning, SP
Aass, N
Mead, GM
Fossa, SD
Oliver, RTD
Horwich, A
Read, G
Roberts, IT
Rustin, G
Cullen, MH
Kaye, SB
Harland, SJ
Cook, PA
机构
[1] UCL, SCH MED, MIDDLESEX HOSP, DEPT ONCOL, LONDON W1N 8AA, ENGLAND
[2] MRC, CANC TRIALS OFF, CAMBRIDGE, ENGLAND
[3] NORWEGIAN RADIUM HOSP, OSLO, NORWAY
[4] ROYAL S HANTS HOSP, SOUTHAMPTON SO9 4PE, HANTS, ENGLAND
[5] ST BARTHOLOMEWS HOSP, SCH MED, LONDON, ENGLAND
[6] ROYAL LONDON HOSP, LONDON E1 1BB, ENGLAND
[7] ROYAL MARSDEN NHS TRUST, SUTTON, SURREY, ENGLAND
[8] CHRISTIE HOSP NHS TRUST, MANCHESTER M20 4BX, LANCS, ENGLAND
[9] NO CTR CANC TREATMENT, NEWCASTLE UPON TYNE, TYNE & WEAR, ENGLAND
[10] MT VERNON HOSP, NORTHWOOD, MIDDX, ENGLAND
[11] QUEEN ELIZABETH HOSP, BIRMINGHAM B15 2TH, W MIDLANDS, ENGLAND
[12] WESTERN INFIRM & ASSOCIATED HOSP, BEATSON ONCOL CTR, GLASGOW G11 6NT, LANARK, SCOTLAND
关键词
metastatic seminoma; postchemotherapy radiotherapy; cisplatin;
D O I
10.1016/S0959-8049(97)00033-6
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
In a retrospective study, data from 302 patients with metastatic testicular seminoma treated with chemotherapy between 1978 and 1990 in 10 European centres were analysed to evaluate the role, if any, of postchemotherapy treatment with irradiation. The primary endpoint of this study was the progression-free survival rate after chemotherapy with or without additional radiotherapy. This was related to the type of primary chemotherapy, sites and sizes of pre- and postchemotherapy masses, the extent of surgical resection after chemotherapy and the use of radiotherapy. 174 patients had residual disease at the end of chemotherapy. The most important prognostic factors for progression were the presence of any visceral metastases or raised LDH prechemotherapy, and the presence of residual disease at visceral sites after chemotherapy. Approximately half the patients with residual masses underwent postchemotherapy radiotherapy, with selection based predominantly on institutional practice. In patients receiving platinum-based chemotherapy, no significant difference was detected in progression-free survival whether or not radiotherapy was employed. Patients receiving BEP (bleomycin, etoposide and cisplatin) had a progression-free survival rate of 88% (95% CI, 80-96%) uninfluenced by postchemotherapy radiotherapy. In patients with residual masses confined to the abdomen after platinum-based chemotherapy, the absolute benefit to radiotherapy was estimated to be 2.3%. The potential benefit of postchemotherapy radiotherapy is minimal, and so it is concluded that the use of adjuvant radiotherapy to residual masses after platinum-based chemotherapy for metastatic seminoma is unnecessary. (C) 1997 Elsevier Science Ltd.
引用
收藏
页码:829 / 835
页数:7
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