临床I期非精原细胞瘤治疗方案

RPLND. As described above, this is surgery to remove the retroperitoneal lymph nodes that lie at the back of the abdomen. After an RPLND, the risk of recurrence is less than 10% if no cancer is found at surgery. Most of these recurrences occur in the lungs or the lymph nodes in the chest and they almost always occur within two years after the RPLND.
在诊断时，有些小的转移性肿瘤不能被CT扫描发现，随着时间的推移，因为肿瘤变大，而被发现；临床一期非精原细胞瘤的患者大约有1/3会发生这种情况。另外的2/3患者都可以在睾丸删除以后成功治愈。临床一期非精原细胞瘤的复发多数在诊断后9个月内发生，发生在后腹膜。临床一期癌症的治疗选择如下：
Active surveillance. This option involves CT scans of the abdomen and pelvis every three to six months for the first year, every four to nine months in the second year, and every six to twelve months in the third to fifth year. Chest x-rays with physical examinations and tumor marker tests to measure HCG and AFP are done every one to two months for the first 12 months, every two to three months in the second year, every three to four months in the third and fourth years, every six months in the fifth year, and then annually. If the cancer recurs, three cycles of chemotherapy successfully treats more than 95% of men. RPLND may be used to treat recurrent cancer if it is limited to the retroperitoneal lymph nodes.
Clinical stage I non-seminoma testicular cancer
临床I期非精原细胞瘤睾丸癌
About one-third of patients with clinical stage I non-seminoma have small areas of metastatic cancer that cannot be seen by CT scans when diagnosed but will grow and be found with time. The rest are cured by having their testicle removed. Most recurrences of stage I non-seminoma occur within nine months after diagnosis and occur in the retroperitoneum. The options for men with clinical stage I disease are:
化疗。此方案在手术切除睾丸不久后实施，称为辅助化疗。最常用的方法是给两、三个周期治疗，博莱霉素，依托泊苷（Toposar，VePesid），顺铂，该方案称为BEP。这种方法的优点是，它把复发率从30％降低到不足3％。主要缺点是，70％的患者不需要化疗，因为他们已经通过睾丸切除手术治愈。因此，一些医生不建议临床一期使用化疗；其它一些医生建议只对较高的复发风险的人使用辅助化疗，避免不必要的治疗。
主动监测。此方案包括：腹部和骨盆CT扫第五年，每六到十二个月）。胸部X光检查与体检，HCG和AFP的肿瘤标志物检查（前12个月，进行每隔一至两个月；在第二年，每两至三个月；在第三和第四年，每三至四个月；第五个年每六个月；然后每年体检）。
如果癌症复发，3个周期的化疗成功率将超过95％。如果症状仅限于腹膜后淋巴结， RPLND也可用于治疗癌症复发。
RPLND腹膜后淋巴结清扫。如上所述，这个手术切除腹部背面的腹膜后淋巴结。RPLND后，在手术中发现，如果没有发现癌细胞，复发的风险是小于10％。这些复发大多数发生在肺或胸部淋巴结，他们几乎总是发生在RPLND手术后两年以内。
Chemotherapy. This option involves undergoing chemotherapy shortly after the testicle has been removed surgically, called adjuvant chemotherapy. The most commonly used approach has been to give two, three-week cycles of bleomycin, etoposide (Toposar, VePesid), and cisplatin, a regimen called BEP. The advantage of this approach is that it lowers the recurrence rate from 30% down to less than 3%. The main disadvantage is that 70% of patients do not need chemotherapy because they have already been cured with the surgical removal of the testicle. Therefore, some doctors recommend not using chemotherapy for clinical stage I non-seminoma, while others may recommend using adjuvant chemotherapy only for men who have a higher risk of recurrence so that fewer men receive unnecessary treatment.