Page 12 - Guideline

09010:Layout 1 3/18/10 9:26 PM Page E30

Wood et al.

Table 8. Summary of randomized studies in advanced germ cell tumours

Author Year Risk stratification No. patients Treatment Results
Good-risk patients
Bosl 106 1988 MSKCC 164 EP × 4 No difference
VABcCy × 4 EP less toxic
Einhorn 98 1989 Indiana 184 BEP × 3 No difference
BEP × 4 BEP × 3 less toxic
de Wit 99 2001 MRC/EORTC 812 BEP × 3 No difference
BEP × 4 BEP × 3 less toxic
5 days less toxic vs. 3 days
Culine 100 2007 Institut Gustave 262 BEP × 3 Equivalent RR
Roussy EP × 4 Survival underpowered
Role of bleomycin in good-risk patients
Levi 194 1993 AGCTG 218 PVP Equivalent RR but less
VP cancer deaths with PVB
Loehrer 105 1995 Indiana 171 BEP × 3 BEP × 3 superior
EP × 3
de Wit 195 1997 IGCCC 395 BE360P × 4 BE 360 P × 4 superior
E360P × 4
Culine 100 2007 Institut Gustave 262 BEP × 3 Equivalent RR
Roussy EP × 4 Survival underpowered
Role of carboplatin
Bajorin 103 1993 MSKCC Good 265 EP × 4 EP × 4 superior
Risk E Carbo × 4
Horowich 102 1997 MRC/EORTC 598 BE 360 P × 4 BE360P × 4 superior
Good Risk BE 360 Carbo × 4
Intermediate and poor risk
Nichols 108 1998 Indiana Advanced 304 BEP × 4 No difference
(= IGCCC - VIP × 4 BEP × 4 less toxic
intermediate and
poor)
de Wit 110 1998 IGCCC (good, 84 BEP × 4 No difference (closed early)
intermediate, VIP × 4
poor)
Droz 112 2007 IGCCC 114 PVeB × 4 No difference
(intermediate, HDCT
poor)

Motzer 111 2007 IGCCC 219 BEP × 4 No difference
(intermediate, HDCT
poor)
MSKCC = Memorial Sloan-Kettering Cancer Center; EP = etoposide and cisplatin; VABcCy = vinblastine + bleomycin + cisplatin + cyclophosphamide + dactinomycin;
BEP = bleomycin, etoposide, platinum; RR = response rate; MRC = Mediacl Research Council; EORTC = European Organization for Research and Treatment of Cancer;
AGCTG = Australasian Germ Cell Trial Group; IGCCC = International Germ Cell Consensus Classification; PVP = polyvinylpyrrolidone; VP = etoposide ; E Carbo = etoposide and carboplatin;
BE Carbo = bleomycin, etoposide and carboplatin; VIP = cisplatin; PVB = cisplatin [platinol-AQ], vinblastine, bleomycin.

be resected including those smaller than 1 cm. 134 A small These include: (1) removal of the visible or palpable mass
minority felt that even patients with completely normal radi- and then a limited RPLND, (2) a strategy guided by intra-
ologically imaging should undergo RPLND to try to pre- operative findings such that if the frozen section showed
vent late relapses. 135,136 teratoma or viable cancer, a full bilateral RPLND would
If one were to decide on a RPLND, historically different be done and if only fibrosis or necrosis is seen, a limited RPLND
options for the extent of resection have been recommended. would be performed, (3) a modified RPLND in selected patients,

E30 CUAJ • April 2010 • Volume 4, Issue 2