What are the indications for postchemotherapy retroperitoneal lymph node dissection?

摘要

Platinum combination chemotherapy has dramatically altered the survival curves for all stages of testicular cancer. We entered our first patient in August 1974 on our phase II trial of the then experimental drug, cisplatin, combined with vinblastine + bleomycin (PVB) [1]. This study immediately transformed metastatic testicular cancer from a highly fatal disease to a model for a curable neoplasm, as over 50% of our 47 patients on our first PVB trial achieved durable complete remission with chemotherapy alone or with postchemotherapy retroperitoneal lymph node dissection (RPLND) (5 patients). This single-institution phase II trial led to the approval by regulatory agencies of cisplatin as a component of combination chemotherapy, despite never having been subjected to the rigors of a phase III trial. Subsequent PVB studies, carried out mainly at Indiana University and through the American Co-operative Groups and in Europe, demonstrated the reduction of the vinblastine dose and elimination of 2 years of maintenance vinblastine would mitigate acute toxicity without compromising cure rates.