Abstract :
[en] To clarify the controversy about the management and prognosis of human chorionic gonadotropin-producing seminoma, the records of 132 patients with abnormal human chorionic gonadotropin values treated with radiotherapy were analyzed. METHODS AND MATERIALS: The records of 1169 patients with pure seminoma treated in 10 institutions were screened for serum or urinary human chorionic gonadotropin. One hundred and thirty two patients with elevated human chorionic gonadotropin were found: 96 Stage I, 20 IIA, 7 IIB, 8 III and 1 IV. Median age was 34 y., mean follow-up was 5.0 years [range 1-12 y]. All received infradiaphragmatic radiotherapy (median dose 30 Gy), 25 (2 Stage I, 11 IIA, 5 IIB and 7 III) supradiaphragmatic radiotherapy (median dose: 28.5 Gy) and 10 had also initial chemotherapy (3 Stage IIB 6 III and 1 IV). Patients were allocated to three groups according to human chorionic gonadotropin values: (a) moderate elevation: up to 10 times (104 pts), (b) high elevation: 10 to 100 times (20 pts), (c) very high elevation: over 100 times the upper limit of normal value (8 pts). RESULTS: The proportion of Stage I, II and III was 76%, 19%, 5% in the ME group versus 50%, 35%, 15% in the high elevation group (p < 0.05). In the very high elevation group there were 7 Stage I and 1 Stage IV. Of 132 patients, six died (three dead of disease, two suicides, one acquired immunodeficiency syndrome). The 5 years overall survival probability was 94%. There were seven recurrences (initial stage: 1 Stage I, 2 IIB, 3 III and 1 IV). Of these, there were one in-field recurrence, 3 out of field and 3 in both sites. In 5 of 7, the human chorionic gonadotrophin level was again elevated at recurrence. The 5 years recurrence-free-survival probability was 94% (98% for Stage I, 100% for Stage IIA and 65% for Stage IIB and III [p < 0.001 between I and IIB + III, p < 0.05 between IIA and IIB + III]). Four of the 7 recurrences were salvaged by chimiotherapy +/- radiotherapy. In the high elevation and very high elevation groups, the 5 years recurrence-free-survival was 88%, vs. 96% for the moderate elevation group (p = 0.10). CONCLUSION: Based on this series of patients, human chorionic gonadotropin production is not an unfavorable prognostic factor in pure seminoma. Even in the subgroups with high or very high human chorionic gonadotropin levels (who had a higher proportion of advanced stages), the prognosis remained excellent. In Stage I and IIA seminoma with abnormal human chorionic gonadotropin levels, recurrence rate after post-operative radiotherapy alone is extremely low.
[fr] Afin de clarifier la controverse sur la gestion et le pronostic de la gonadotrophine chorionique humaine séminomateux production, les dossiers de 132 patients avec la gonadotrophine chorionique humaine anormale valeurs traitées par radiothérapie ont été analysés. METHODS AND MATERIALS: The records of 1169 patients with pure seminoma treated in 10 institutions were screened for serum or urinary human chorionic gonadotropin. METHODES ET MATERIAUX: Les dossiers de 1169 patients atteints de séminome pur traités dans 10 institutions ont été présélectionnés pour le sérum ou des voies urinaires gonadotrophine chorionique humaine. One hundred and thirty two patients with elevated human chorionic gonadotropin were found: 96 Stage I, 20 IIA, 7 IIB, 8 III and 1 IV. Cent trente deux patients avec la gonadotrophine chorionique humaine élevés ont été trouvés: 96 stade I, 20 II A, II B 7, 8 III et 1 IV. Median age was 34 y., mean follow-up was 5.0 years [range 1-12 y]. L'âge médian était de 34 y., suivi moyen était de 5,0 ans [extrêmes 1-12 Y]. All received infradiaphragmatic radiotherapy (median dose 30 Gy), 25 (2 Stage I, 11 IIA, 5 IIB and 7 III) supradiaphragmatic radiotherapy (median dose: 28.5 Gy) and 10 had also initial chemotherapy (3 Stage IIB 6 III and 1 IV). Tous ont reçu une radiothérapie infradiaphragmatic (dose médiane de 30 Gy), 25 (2 Phase I, 11 II, 5 II B et 7 III) radiothérapie supradiaphragmatic (dose médiane: 28,5 Gy) et 10 avaient aussi une chimiothérapie initiale (3 Étape II B 6 III et 1 IV ). Patients were allocated to three groups according to human chorionic gonadotropin values: (a) moderate elevation: up to 10 times (104 pts), (b) high elevation: 10 to 100 times (20 pts), (c) very high elevation: over 100 times the upper limit of normal value (8 pts). Les patients ont été répartis en trois groupes en fonction de valeurs de la gonadotrophine chorionique humaine: (a) élévation modérée: jusqu'à 10 fois (104 pts), (b) de haute altitude: 10 à 100 fois (20 pts), (c) d'altitude très élevée: plus de 100 fois la limite supérieure de la valeur normale (8 pts). RESULTS: The proportion of Stage I, II and III was 76%, 19%, 5% in the ME group versus 50%, 35%, 15% in the high elevation group (p < 0.05). RÉSULTATS: La proportion de la phase I, II et III a été de 76%, 19%, 5% dans le groupe ME versus 50%, 35%, 15% dans le groupe de haute altitude (p <0,05). In the very high elevation group there were 7 Stage I and 1 Stage IV. Dans le groupe de très haute altitude il ya eu 7 du stade I et 1 stade IV. Of 132 patients, six died (three dead of disease, two suicides, one acquired immunodeficiency syndrome). De 132 patients, six morts (trois morts de la maladie, deux suicides, l'un syndrome d'immunodéficience acquise). The 5 years overall survival probability was 94%. Les 5 années de probabilité de survie globale était de 94%. There were seven recurrences (initial stage: 1 Stage I, 2 IIB, 3 III and 1 IV). Il ya eu sept récidives (première étape: 1 stade I, 2 IIB, 3 III et IV, 1). Of these, there were one in-field recurrence, 3 out of field and 3 in both sites. Parmi eux, il y avait un en-récurrence de terrain, 3 sur le terrain et 3 dans les deux sites. In 5 of 7, the human chorionic gonadotrophin level was again elevated at recurrence. Dans 5 des 7, le niveau de gonadotrophine chorionique humaine a de nouveau été élevée à la récidive. The 5 years recurrence-free-survival probability was 94% (98% for Stage I, 100% for Stage IIA and 65% for Stage IIB and III [p < 0.001 between I and IIB + III, p < 0.05 between IIA and IIB + III]). Les 5 années aucune récurrence probabilité de survie était de 94% (98% pour les stades I, 100% pour la phase II et 65% pour les stades IIB et III [p <0,001 entre I et II B + III, p <0,05 entre l'IIA et IIB + III]). Four of the 7 recurrences were salvaged by chimiotherapy +/- radiotherapy. Quatre des 7 récidives ont été récupérés par chimiothérapie + / - radiothérapie. In the high elevation and very high elevation groups, the 5 years recurrence-free-survival was 88%, vs. 96% for the moderate elevation group (p = 0.10). Dans la haute altitude et les groupes d'élévation très élevé, les 5 ans sans récidive de survie était de 88%, contre 96% pour le groupe d'élévation modérée (p = 0,10). CONCLUSION: Based on this series of patients, human chorionic gonadotropin production is not an unfavorable prognostic factor in pure seminoma. CONCLUSION: Sur la base de cette série de patients, la production de gonadotrophine chorionique humaine n'est pas un facteur pronostique défavorable dans séminome pur. Even in the subgroups with high or very high human chorionic gonadotropin levels (who had a higher proportion of advanced stages), the prognosis remained excellent. Même dans les sous-groupes à haut ou très haut niveaux de gonadotrophine chorionique humaine (qui avait une plus grande proportion de stades avancés), le pronostic est demeuré excellent. In Stage I and IIA seminoma with abnormal human chorionic gonadotropin levels, recurrence rate after post-operative radiotherapy alone is extremely low. Au stade I et IIA séminome avec des taux anormaux de gonadotrophine chorionique humaine, le taux de récidive après radiothérapie post-opératoire seule est extrêmement faible.
Mirimanoff, R-O; University Hospitals, Lausanne > Radiation Oncology
Sinzig, M; University Hospitals, Lausanne > Radiation Oncology
Krüger, M; University Hospitals, Lausanne > Radiation Oncology
Miralbell, Raymond; University Hospitals, Lausanne > Radiation Oncology
Thöni, A; University Hospitals, Lausanne > Radiation Oncology
Ries, G; University Hospitals, Lausanne > Radiation Oncology
Bosset, J-F; University Hospitals, Lausanne > Radiation Oncology
Bernier, J; University Hospitals, Lausanne > Radiation Oncology
Bolla, M; University Hospitals, Lausanne > Radiation Oncology
Nguyen, T-D; University Hospitals, Lausanne > Radiation Oncology
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