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Chavarriaga J, Bobrowski A, Hamilton RJ. Guideline of guidelines: follow-up after orchidectomy for clinical stage 1 testicular cancer. BJU Int 2023; 132:485-495. [PMID: 37409830 DOI: 10.1111/bju.16111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Several medical organisations have developed evidence-based guidelines for the diagnosis, management, and follow-up of testicular cancer. This article aimed to review, compare, and summarise the most updated international guidelines and surveillance protocols for clinical stage 1 (CS1) testicular cancer. We reviewed a total of 46 articles on proposed follow-up strategies for testicular cancer, and six clinical practice guidelines including four guidelines published by urological scientific associations and two guidelines published by medical oncology associations. Most of these guidelines have been developed by panels of experts with different backgrounds in clinical training, and geographic practise patterns, which explains the considerable variability between published schedules, and recommended follow-up intensity. We present you with a comprehensive review of the most important clinical practice guidelines and propose unifying recommendations based on the most up to date evidence to help standardise follow-up schedules based on patterns and risk of disease relapse.
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Affiliation(s)
- Julian Chavarriaga
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Adam Bobrowski
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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2
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Richardson NH, Althouse SK, Ashkar R, Cary C, Masterson T, Foster RS, Einhorn LH, Adra N. Late Relapse of Germ Cell Tumors After Prior Chemotherapy or Surgery-only. Clin Genitourin Cancer 2023; 21:467-474. [PMID: 37088659 DOI: 10.1016/j.clgc.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Late relapse (LR) of germ cell tumor (GCT) is defined as relapsed disease >2 years from initial treatment. LR remains a challenge both for optimal screening methods and management. We report the method of detection, treatments received, and outcomes in patients with chemotherapy-exposed vs chemotherapy-naïve LR GCT. PATIENTS AND METHODS The Indiana University testicular cancer database was queried identifying 131 patients with LR GCT evaluated at Indiana University from January 2000 to January 2019. Method of detection of LR was recorded along with site, treatment received, and survival outcomes. The cohort was divided into 4 groups according to seminoma versus non-seminoma GCT (NSGCT) and chemotherapy-exposed vs chemotherapy-naïve LR. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method and compared using the log-rank test. Medians with 95% confidence intervals were also calculated along with the 2-year probabilities. RESULTS Median age at LR was 38.3 (range, 19.3-56.8). Chemotherapy-exposed accounted for 75 (57%) and chemotherapy-naïve for 56 (43%) of cases. The 2-year OS comparing chemotherapy-exposed versus chemotherapy-naïve was 78.2% versus 100% (P = .0003). For the 72 chemo-exposed NSGCT LR pts, 2-year PFS based on treatment: surgery vs chemotherapy versus surgery + chemotherapy was 67.1% versus 0% versus 47.1% (P < 0.0001). Fifty-nine percent of chemotherapy-exposed LR had elevation of alpha fetoprotein (AFP) at LR diagnosis. CONCLUSION GCT pts require lifetime follow-up with annual physical exam and tumor markers. Surgical resection, when feasible, remains the preferred treatment for chemotherapy-exposed LR. Chemotherapy-exposed LR has worse outcomes compared to chemotherapy-naïve LR patients.
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Affiliation(s)
- Noah H Richardson
- Division of Hematology & Medical Oncology - Melvin & Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Sandra K Althouse
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Ryan Ashkar
- Division of Hematology & Medical Oncology - Melvin & Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Lawrence H Einhorn
- Division of Hematology & Medical Oncology - Melvin & Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology & Medical Oncology - Melvin & Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
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3
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Gariscsak PJ, Anson-Cartwright L, Atenafu EG, Jiang DM, Chung P, Bedard P, Warde P, O'Malley M, Sweet J, Glicksman RM, Hamilton RJ. Safety of Minimizing Intensity of Follow-up on Active Surveillance for Clinical Stage I Testicular Germ Cell Tumors. EUR UROL SUPPL 2022; 40:46-53. [PMID: 35638085 PMCID: PMC9142749 DOI: 10.1016/j.euros.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/26/2022] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analysis Results and limitations Conclusions Patient summary
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4
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Joffe JK, Cafferty FH, Murphy L, Rustin GJS, Sohaib SA, Gabe R, Stenning SP, James E, Noor D, Wade S, Schiavone F, Swift S, Dunwoodie E, Hall M, Sharma A, Braybrooke J, Shamash J, Logue J, Taylor HH, Hennig I, White J, Rudman S, Worlding J, Bloomfield D, Faust G, Glen H, Jones R, Seckl M, MacDonald G, Sreenivasan T, Kumar S, Protheroe A, Venkitaraman R, Mazhar D, Coyle V, Highley M, Geldart T, Laing R, Kaplan RS, Huddart RA. Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST). J Clin Oncol 2022; 40:2468-2478. [PMID: 35298280 DOI: 10.1200/jco.21.01199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Survival in stage I seminoma is almost 100%. Computed tomography (CT) surveillance is an international standard of care, avoiding adjuvant therapy. In this young population, minimizing irradiation is vital. The Trial of Imaging and Surveillance in Seminoma Testis (TRISST) assessed whether magnetic resonance images (MRIs) or a reduced scan schedule could be used without an unacceptable increase in advanced relapses. METHODS A phase III, noninferiority, factorial trial. Eligible participants had undergone orchiectomy for stage I seminoma with no adjuvant therapy planned. Random assignment was to seven CTs (6, 12, 18, 24, 36, 48, and 60 months); seven MRIs (same schedule); three CTs (6, 18, and 36 months); or three MRIs. The primary outcome was 6-year incidence of Royal Marsden Hospital stage ≥ IIC relapse (> 5 cm), aiming to exclude increases ≥ 5.7% (from 5.7% to 11.4%) with MRI (v CT) or three scans (v 7); target N = 660, all contributing to both comparisons. Secondary outcomes include relapse ≥ 3 cm, disease-free survival, and overall survival. Intention-to-treat and per-protocol analyses were performed. RESULTS Six hundred sixty-nine patients enrolled (35 UK centers, 2008-2014); mean tumor size was 2.9 cm, and 358 (54%) were low risk (< 4 cm, no rete testis invasion). With a median follow-up of 72 months, 82 (12%) relapsed. Stage ≥ IIC relapse was rare (10 events). Although statistically noninferior, more events occurred with three scans (nine, 2.8%) versus seven scans (one, 0.3%): 2.5% absolute increase, 90% CI (1.0 to 4.1). Only 4/9 could have potentially been detected earlier with seven scans. Noninferiority of MRI versus CT was also shown; fewer events occurred with MRI (two [0.6%] v eight [2.6%]), 1.9% decrease (-3.5 to -0.3). Per-protocol analyses confirmed noninferiority. Five-year survival was 99%, with no tumor-related deaths. CONCLUSION Surveillance is a safe management approach-advanced relapse is rare, salvage treatment successful, and outcomes excellent, regardless of imaging frequency or modality. MRI can be recommended to reduce irradiation; and no adverse impact on long-term outcomes was seen with a reduced schedule.
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Affiliation(s)
| | | | - Laura Murphy
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Syed A Sohaib
- Institute of Cancer Research, Royal Marsden Hospital, Sutton, United Kingdom
| | - Rhian Gabe
- Centre for Cancer Prevention, Queen Mary University of London, London, United Kingdom
| | | | | | - Dipa Noor
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Simona Wade
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Sarah Swift
- St James University Hospital, Leeds, United Kingdom
| | | | - Marcia Hall
- Mount Vernon Hospital, Northwood, United Kingdom.,Hillingdon Hospital, Uxbridge, United Kingdom
| | - Anand Sharma
- Mount Vernon Hospital, Northwood, United Kingdom
| | - Jeremy Braybrooke
- Bristol Haematology & Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Jonathan Shamash
- Barts Cancer Institute, St Bartholomews Hospital, London, United Kingdom
| | - John Logue
- The Christie Hospital, Manchester, United Kingdom
| | - Henry H Taylor
- Kent Oncology Centre, Maidstone Hospital, Maidstone, United Kingdom
| | - Ivo Hennig
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jeff White
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Sarah Rudman
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jane Worlding
- University Hospital Coventry and Warwickshire, Coventry, United Kingdom
| | - David Bloomfield
- Royal Sussex County Hospital, Sussex Cancer Centre, Brighton, United Kingdom
| | - Guy Faust
- Northampton General Hospital, Northampton, United Kingdom
| | - Hilary Glen
- University Hospital Ayr, Ayr, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Tom Geldart
- University Hospitals Dorset, Poole, United Kingdom
| | - Robert Laing
- Royal Surrey County Hospital, Guildford, United Kingdom
| | | | - Robert A Huddart
- Institute of Cancer Research, Royal Marsden Hospital, Sutton, United Kingdom
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Baweja A, Mar N, Rezazadeh Kalebasty A. Late recurrence of localized pure seminoma in prostate gland: A case report. World J Clin Oncol 2022; 13:62-70. [PMID: 35116233 PMCID: PMC8790299 DOI: 10.5306/wjco.v13.i1.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/22/2021] [Accepted: 12/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Late relapses of early-stage germ cell tumors are rare. Most patients (-85%) with stage I seminoma are cured by radical orchiectomy. The detection of late relapse is challenging given the relative rarity of this phenomenon, and the fact that patients who have completed surveillance are usually not undergoing regular oncologic workup nor imaging. While many treatment options do exist for a patient with late relapse of seminoma, surgery is typically the mainstay as these tumors are generally thought to be more chemo-resistant.
CASE SUMMARY In this article, we describe the management of a patient with an early-stage pure seminoma who was subsequently identified to have a recurrence two decades later. We provide a review of the literature not only focused on clinical factors and biology, but also the management of late recurrences specifically in pure seminoma and in prostate gland.
CONCLUSION There is a paucity of data and treatment recommendations for this clinical entity, and a multidisciplinary approach emphasizing subspecialty expert consultation and patient education is imperative.
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Affiliation(s)
- Abinav Baweja
- Hematology/Oncology, UCI Medical Center, University of California, Orange, CA 92868, United States
| | - Nataliya Mar
- Hematology/Oncology, UCI Medical Center, University of California, Orange, CA 92868, United States
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Abstract
PURPOSE OF REVIEW Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications. RECENT FINDINGS At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma. SUMMARY Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.
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Affiliation(s)
- Jerusha Padayachee
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Roderick Clark
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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7
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Chen JG, Wang JQ, Peng TW, Chen ZS, Zhao SC. Construction and Validation of a Nomogram for Predicting Progression- Free Survival in Patients with Early-Stage Testicular Germ Cell Tumor. Recent Pat Anticancer Drug Discov 2021; 16:44-53. [PMID: 33573563 DOI: 10.2174/1574892816666210211092108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Testicular Germ Cell Tumor (TGCT) is the most common malignant tumor in young men, but there is a lack of a prediction model to evaluate the prognosis of patients with TGCT. OBJECTIVE To explore the prognostic factors for Progression-Free Survival (PFS) and construct a nomogram model for patients with early-stage TGCT after radical orchiectomy. METHODS Patients with TGCT from The Cancer Genome Atlas (TCGA) database were used as the training cohort; univariate and multivariate cox analysis was performed. A nomogram was constructed based on the independent prognostic factors. Patients from the Nanfang Hospital affiliated with Southern Medical University were used as the cohort to validate the predictive ability using the nomogram model. Harrell's concordance index (C-index) and calibration plots were used to evaluate the nomogram. RESULTS A total of 110 and 62 patients with TGCT were included in the training cohort and validation cohort, respectively. Lymphatic Vascular Invasion (LVI), American Joint Committee on Cancer (AJCC) stage and adjuvant therapy were independent prognostic factors in multivariate regression analyses and were included to establish a nomogram. The C-index in the training cohort for 1- , 3-, and 5-year PFS were 0.768, 0.74, and 0.689, respectively. While the C-index for 1-, 3-, and 5- year PFS in the external validation cohort were 0.853, 0.663 and 0.609, respectively. The calibration plots for 1-, 3-, and 5-year PFS in the training and validation cohort showed satisfactory consistency between predicted and actual outcomes. The nomogram revealed a better predictive ability for PFS than AJCC staging system. CONCLUSION The nomogram as a simple and visual tool to predict individual PFS in patients with TGCT could guide clinicians and clinical pharmacists in therapeutic strategy.
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Affiliation(s)
- Jin-Guo Chen
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, P.R. China
| | - Jing-Quan Wang
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University,
Queens, NY 11439, USA
| | - Tian-Wen Peng
- Reproductive Medicine Center, The Third Affiliated Hospital of Guangzhou Medical University,
Guangzhou 510150, Guangdong, P.R. China
| | - Zhe-Sheng Chen
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University,
Queens, NY 11439, USA
| | - Shan-Chao Zhao
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong, P.R. China,Department of Urology, the Third Affiliated Hospital of Southern Medical University, Guangzhou 510500, Guangdong, P.R. China
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Crocetti S, Tassone L, Torniai M, Pierantoni C, Burattini L, Mandolesi A, Di Benedetto M, Mantello G, Scarpelli M, Berardi R. Seminoma Retroperitoneal Relapse 23 Years After Surgery. Oncol Ther 2021; 9:239-245. [PMID: 33606194 PMCID: PMC8140174 DOI: 10.1007/s40487-021-00141-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 11/25/2022] Open
Abstract
Stage I seminoma is the most frequent tumour in young men. It has a very good prognosis thanks to the use of a multidisciplinary therapeutic approach including surgery, radiotherapy and systemic chemotherapy. Late (after 2 years) and very late (after 5 years) relapses are uncommon, but not impossible, even if standardized follow-up for testicular tumours lasts up to 5 years after the diagnosis. We report a case of a 67-year-old Caucasian man with metachronous bilateral testicular seminoma who developed a retroperitoneal relapse of testicular seminoma 23 years after the first orchiectomy. Based on histological confirmation of testicular relapse, the patient underwent four cycles of systemic chemotherapy with bleomycin, etoposide and cisplatin (PEB), with no adverse reactions. He subsequently achieved complete radiological response at restaging computed tomography imaging, confirmed by the absence of glucose metabolism on positron emission tomography. In conclusion, this case report suggests the importance of longer standardized follow-up for patients treated for testicular tumours in order to detect earlier recurrence, which can be successfully treated.
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Affiliation(s)
- Sonia Crocetti
- Clinica Oncologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy.
| | - Laura Tassone
- Clinica Oncologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
| | - Mariangela Torniai
- Clinica Oncologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
| | - Chiara Pierantoni
- Clinica Oncologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
| | - Luciano Burattini
- Clinica Oncologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
| | - Alessandra Mandolesi
- Anatomia Patologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
| | - Maika Di Benedetto
- Dipartimento di Oncologia e Radioterapia, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giovanna Mantello
- Dipartimento di Oncologia e Radioterapia, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Marina Scarpelli
- Anatomia Patologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche - AOU Ospedali Riuniti, Ancona, Italy
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Fukushima T, Noguchi T, Kobayashi T, Sekiguchi N, Ozawa T, Koizumi T, Tamada H. Late and Rapid Relapse in Mediastinum from Testicular Germ Cell Tumor Stage I Over 13 Years after Surgery. Case Rep Oncol 2019; 12:500-505. [PMID: 31320874 PMCID: PMC6616051 DOI: 10.1159/000501446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Patients with stage I testicular germ cell tumors have a long life expectancy, but the tumors have a potential to relapse after treatment. Although relapse is observed within a few years in most cases, late relapse over 10 years after initial treatment has also been reported in patients with stage I testicular germ cell tumors. We encountered a case of testicular seminoma that developed mediastinal lymph node metastasis 13 years after radical surgery for the primary tumor. The relapsed disease progressed rapidly and the patient died within 1 month due to respiratory failure without any chance for therapy. On postmortem examination, the thoracic lesions were pathologically confirmed to be metastases from the testicular seminoma with yolk sac tumor. Here, we report the clinical course and a review of the relevant literature. Based on our experience, we emphasize long-term follow-up and/or careful examination in patients with stage I testicular germ cell tumors.
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Affiliation(s)
- Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuro Noguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Kobayashi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Nodoka Sekiguchi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takesumi Ozawa
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hisashi Tamada
- Department of Central Laboratory, Shinshu University School of Medicine, Matsumoto, Japan
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10
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Management of Clinical Stage I (CSI) Disease in Testicular Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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11
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Abstract
Testicular cancer is the most common malignancy among men between 14 and 44 years of age, and its incidence has risen over the past two decades in Western countries. Both genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism is the most common risk factor. Progress has been made in our understanding of the disease since the initial description of carcinoma in situ of the testis in 1972 (now referred to as germ cell neoplasia in situ), which has led to improved treatment options. The combination of surgery and cisplatin-based chemotherapy has resulted in a cure rate of >90% in patients with testicular cancer, although some patients become refractory to chemotherapy or have a late relapse; an improved understanding of the molecular determinants underlying tumour sensitivity and resistance may lead to the development of novel therapies for these patients. This Primer provides an overview of the biology, epidemiology, diagnosis and current treatment guidelines for testicular cancer, with a focus on germ cell tumours. We also outline areas for future research and what to expect in the next decade for testicular cancer.
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Dissecting the Evolving Risk of Relapse over Time in Surveillance for Testicular Cancer. Adv Urol 2018; 2018:7182014. [PMID: 29670653 PMCID: PMC5836309 DOI: 10.1155/2018/7182014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/27/2017] [Indexed: 01/10/2023] Open
Abstract
Testicular cancer is the most common malignancy in young men, and the incidence is increasing in most countries worldwide. The vast majority of patients present with clinical stage I disease, and surveillance is being increasingly adopted as the preferred management strategy. At the time of diagnosis, patients on surveillance are often counselled about their risk of relapse based on risk factors present at diagnosis, but this risk estimate becomes less informative in patients that have survived a period of time without experiencing relapse. Conditional survival estimates, on the other hand, provide information on a patient's evolving risk of relapse over time. In this review, we describe the concept of conditional survival and its applications for surveillance of clinical stage I seminoma and nonseminoma germ cell tumours. These estimates can be used to tailor surveillance protocols based on future risk of relapse within risk subgroups of seminoma and nonseminoma, which may reduce the burden of follow-up for some patients, physicians, and the health care system. Furthermore, conditional survival estimates provide patients with a meaningful, evolving risk estimate and may be helpful to reassure patients and reduce potential anxiety of being on surveillance.
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13
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Krege S. Management of Clinical Stage I (CSI) Disease in Testicular Cancer. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Lieng H, Warde P, Bedard P, Hamilton RJ, Hansen AR, Jewett MAS, O'malley M, Sweet J, Chung P. Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach. Can Urol Assoc J 2017; 12:59-66. [PMID: 29381453 DOI: 10.5489/cuaj.4531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Testicular seminoma most commonly affects young men and is associated with favourable prognosis. Various followup schedules and imaging protocols for testicular seminoma have been described without overall consensus. We reviewed the literature together with our experience at the Princess Margaret Cancer Centre and present an evidence-based followup approach for patients with stage I and II seminoma.
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Affiliation(s)
- Hester Lieng
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
| | - Philippe Bedard
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto; Toronto, ON, Canada
| | - Robert J Hamilton
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto; Toronto, ON, Canada
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Martin O'malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University of Toronto; Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
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