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Rohozneanu EF, Deac C, Căinap CI. A Systematic Review Investigating the Difference between 1 Cycle versus 2 Cycles of Adjuvant Chemotherapy in Stage I Testicular Germ Cell Cancers. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:916. [PMID: 37241148 PMCID: PMC10223662 DOI: 10.3390/medicina59050916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023]
Abstract
Standard care for stage I testicular germ cell cancers (seminomatous-STC or non-seminomatous-NSTC) is orchiectomy followed by active surveillance, 1 or 2 cycles of adjuvant chemotherapy, surgery or radiotherapy. The decision on the adjuvant therapeutic approach is guided by the associated risk factors of the patient and the potential related toxicity of the treatment. Currently, there is no consensus regarding the optimal number of adjuvant chemotherapy cycles. Although in terms of overall survival, there is no proven inconsistency regarding the number of cycles of adjuvant chemotherapy, and the rate of relapse may vary.
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Affiliation(s)
- Emanuiela Florentina Rohozneanu
- Department of Oncology, The Oncology Institute “Prof. Dr. Ion Chiricuţă” Cluj-Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ciprian Deac
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Călin Ioan Căinap
- Department of Oncology, The Oncology Institute “Prof. Dr. Ion Chiricuţă” Cluj-Napoca, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania
- Department of Oncology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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2
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Lesko P, Chovanec M, Mego M. Biomarkers of disease recurrence in stage I testicular germ cell tumours. Nat Rev Urol 2022; 19:637-658. [PMID: 36028719 DOI: 10.1038/s41585-022-00624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Stage I testicular cancer is a disease restricted to the testicle. After orchiectomy, patients are considered to be without disease; however, the tumour is prone to relapse in ~4-50% of patients. Current predictive markers of relapse, which are tumour size and invasion to rete testis (in seminoma) or lymphovascular invasion (in non-seminoma), have limited clinical utility and are unable to correctly predict relapse in a substantial proportion of patients. Adjuvant therapeutic strategies based on available biomarkers can lead to overtreatment of 50-85% of patients. Discovery and implementation of novel biomarkers into treatment decision making will help to reduce the burden of adjuvant treatments and improve patient selection for adjuvant therapy.
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Affiliation(s)
- Peter Lesko
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia.
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Dieckmann KP, Pokrivcak T, Geczi L, Niehaus D, Dralle-Filiz I, Matthies C, Dienes T, Zschäbitz S, Paffenholz P, Gschliesser T, Pichler R, Mego M, Bader P, Zengerling F, Heinzelbecker J, Krausewitz P, Krege S, Aurilio G, Aksoy C, Hentrich M, Seidel C, Törzsök P, Nestler T, Majewski M, Hiester A, Buchler T, Vallet S, Studentova H, Schönburg S, Niedersüß-Beke D, Ring J, Trenti E, Heidenreich A, Wülfing C, Isbarn H, Pichlmeier U, Pichler M. Single-course bleomycin, etoposide, and cisplatin (1xBEP) as adjuvant treatment in testicular nonseminoma clinical stage 1: outcome, safety, and risk factors for relapse in a population-based study. Ther Adv Med Oncol 2022; 14:17588359221086813. [PMID: 35386956 PMCID: PMC8977693 DOI: 10.1177/17588359221086813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Clinical stage 1 (CS1) nonseminomatous (NS) germ cell tumors involve a 30% probability of relapse upon surveillance. Adjuvant chemotherapy with one course of bleomycin, etoposide, and cisplatin (1xBEP) can reduce this risk to <5%. However, 1xBEP results are based solely on five controlled trials from high-volume centers. We analyzed the outcome in a real-life population. Patients and Methods: In a multicentric international study, 423 NS CS1 patients receiving 1xBEP were retrospectively evaluated. Median follow-up was 37 (range, 6–89) months. Primary end points were relapse-free and overall survival evaluated after 5 years. We also looked at associations of relapse with clinico-pathological factors using stratified Kaplan–Meier methods and Cox regression models. Treatment modality and outcome of recurrences were analyzed descriptively. Results: The 5-year relapse-free survival rate was 96.2%. Thirteen patients (3.1%; 95% confidence interval, 1.65–5.04%) relapsed after a median time of 13 months, of which 10 were salvaged (77%). Relapses were mostly confined to retroperitoneal nodes. Three patients succumbed, two to disease progression and one to toxicity of chemotherapy. Pathological stage >pT2 was significantly associated with relapse rate. Conclusion: The relapse rate of 3.1% found in this population of NS CS1 patients treated with 1xBEP at the routine care level was not inferior to the median rate of 2.3% reported from a meta-analysis of controlled trials. Also, the cure rate of relapses of 77% is consistent with the previously reported rate of 80%. This study clearly shows that the 1xBEP regimen represents a safe treatment for NS CS1 patients.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763 Hamburg, Germany
- Department of Urology, Albertinen-Krankenhaus, Hamburg, Germany
| | - Tomas Pokrivcak
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Masaryk University, Brno, Czech Republic
| | - Lajos Geczi
- National Institute of Oncology, Budapest, Hungary
| | - David Niehaus
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | | | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Tamas Dienes
- National Institute of Oncology, Budapest, Hungary
| | - Stefanie Zschäbitz
- Department of Medical Oncology, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Pia Bader
- Department of Urology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | | | - Julia Heinzelbecker
- Department of Urology and Pediatric Urology, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Philipp Krausewitz
- Department of Urology and Pediatric Urology, Universitätsklinikum Bonn, Bonn, Germany
| | - Susanne Krege
- Department of Urology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Gaetano Aurilio
- Medical Oncology Division of Urogenital and Head and Neck Tumours, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Cem Aksoy
- Klinik und Poliklinik für Urologie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - Christoph Seidel
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Péter Törzsök
- Department of Urology and Andrology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Tim Nestler
- Department of Urology, Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Germany
| | | | - Andreas Hiester
- Department of Urology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tomas Buchler
- Department of Oncology, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Sonia Vallet
- Department of Internal Medicine II, Universitätsklinikum Krems, Krems, AustriaDepartment of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Hana Studentova
- Department of Oncology, Palacký University Medical School and Teaching Hospital, Olomouc, Czech Republic
| | - Sandra Schönburg
- Department of Urology, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | | | - Julia Ring
- Department of Urology, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Emanuela Trenti
- Department of Urology, Central Hospital Bolzano, Bolzano, Italy
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Hendrik Isbarn
- Martini-Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Pichler
- Division of Oncology, Medical University of Graz, Graz, Austria
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Kliesch S, Schmidt S, Wilborn D, Aigner C, Albrecht W, Bedke J, Beintker M, Beyersdorff D, Bokemeyer C, Busch J, Classen J, de Wit M, Dieckmann KP, Diemer T, Dieing A, Gockel M, Göckel-Beining B, Hakenberg OW, Heidenreich A, Heinzelbecker J, Herkommer K, Hermanns T, Kaufmann S, Kornmann M, Kotzerke J, Krege S, Kristiansen G, Lorch A, Müller AC, Oechsle K, Ohloff T, Oing C, Otto U, Pfister D, Pichler R, Recken H, Rick O, Rudolph Y, Ruf C, Schirren J, Schmelz H, Schmidberger H, Schrader M, Schweyer S, Seeling S, Souchon R, Winter C, Wittekind C, Zengerling F, Zermann DH, Zillmann R, Albers P. Management of Germ Cell Tumours of the Testis in Adult Patients. German Clinical Practice Guideline Part I: Epidemiology, Classification, Diagnosis, Prognosis, Fertility Preservation, and Treatment Recommendations for Localized Stages. Urol Int 2021; 105:169-180. [PMID: 33412555 DOI: 10.1159/000510407] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION This is the first German evidence- and consensus-based clinical guideline on diagnosis, treatment, and follow-up on germ cell tumours (GCTs) of the testis in adult patients. We present the guideline content in two publications. Part I covers the topic's background, methods, epidemiology, classification systems, diagnostics, prognosis, and treatment recommendations for the localized stages. METHODS An interdisciplinary panel of 42 experts including 1 patient representative developed the guideline content. Clinical recommendations and statements were based on scientific evidence and expert consensus. For this purpose, evidence tables for several review questions, which were based on systematic literature searches (last search was in March 2018) were provided. Thirty-one experts entitled to vote, rated the final clinical recommendations and statements. RESULTS We provide 161 clinical recommendations and statements. We present information on the quality of cancer care and epidemiology and give recommendations for staging and classification as well as for diagnostic procedures. The diagnostic recommendations encompass measures for assessing the primary tumour as well as procedures for the detection of metastases. One chapter addresses prognostic factors. In part I, we separately present the treatment recommendations for germ cell neoplasia in situ, and the organ-confined stages (clinical stage I) of both seminoma and nonseminoma. CONCLUSION Although GCT is a rare tumour entity with excellent survival rates for the localized stages, its management requires an interdisciplinary approach, including several clinical experts. Quality of care is highly related to institutional expertise and can be reassured by established online-based second-opinion boards. There are very few studies on diagnostics with good level of evidence. Treatment of metastatic GCTs must be tailored to the risk according to the International Germ Cell Cancer Collaboration Group classification after careful diagnostic evaluation. An interdisciplinary approach as well as the referral of selected patients to centres with proven experience can help achieve favourable clinical outcomes.
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Affiliation(s)
- Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany,
| | | | - Doris Wilborn
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | - Clemens Aigner
- Ruhrlandklinik at University Hospital Essen, Essen, Germany
| | - Walter Albrecht
- Department of Urology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | - Jens Bedke
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | | | - Dirk Beyersdorff
- Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Busch
- Department of Urology, Charité University Hospital, Berlin, Germany
| | - Johannes Classen
- Department of Radiotherapy, Radiological Oncology and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany
| | - Maike de Wit
- Clinic for Internal Medicine - Hematology, Oncology and Palliative Medicine, Vivantes Clinic Neukölln, Berlin, Germany
| | | | - Thorsten Diemer
- Clinic and Polyclinic for Urology, Pediatric Urology and Andrology, University Hospital Gießen, Gießen, Germany
| | - Anette Dieing
- Clinic for Internal Medicine - Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany
| | | | | | - Oliver W Hakenberg
- Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | | | - Kathleen Herkommer
- Urological Clinic and Polyclinic of the Technical University of Munich, Munich, Germany
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sascha Kaufmann
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | - Marko Kornmann
- Clinic for General and Visceral Surgery, University Hospital Ulm, Ulm, Germany
| | - Jörg Kotzerke
- Klinik und Poliklinik für Nuklearmedizin, University Hospital Dresden, Dresden, Germany
| | - Susanne Krege
- KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany
| | | | - Anja Lorch
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Karin Oechsle
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Timur Ohloff
- Advisor, German Foundation for Young Adults with Cancer, Berlin, Germany
| | - Christoph Oing
- II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Otto
- Urological Competence Centre for Rehabilitation, Bad Wildungen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Renate Pichler
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Heinrich Recken
- HFH, Hamburger Fern-Hochschule Studienzentrum Essen (Distance Learning University, Essen Study Centre), Essen, Germany
| | - Oliver Rick
- Klinik Reinhardshöhe GmbH, Bad Wildungen, Germany
| | | | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Ulm, Germany
| | | | - Hans Schmelz
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany
| | - Heinz Schmidberger
- Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany
| | | | | | | | - Rainer Souchon
- Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany
| | | | | | | | | | | | - Peter Albers
- Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
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Abstract
Experience demonstrates multiple paths to cure for patients with clinical stage I testicular cancer. Because all options should provide a long-term disease-free rate near 100%, overall survival is no longer relevant in decision making, allowing practitioners to factor in quality of life, toxicity, cost, and impact on compliance. Surveillance for clinical stage I seminoma and clinical stage I nonseminoma has become the preferred option. The contrarian view is that a risk-adapted approach should persist, with surveillance for low-risk individuals and active therapy high-risk individuals. However, results obtained in unselected patients provide a strong argument against the need for such an approach.
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Affiliation(s)
- Bruce J Roth
- Division of Oncology/BMT, Department of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, CB 8056, St Louis, MO 63110, USA.
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Weibring K, Nord C, Ståhl O, Eberhard J, Sandberg K, Johansson H, Arver S, Giwercman A, Cohn-Cedermark G. Sperm count in Swedish clinical stage I testicular cancer patients following adjuvant treatment. Ann Oncol 2019; 30:604-611. [PMID: 30798330 DOI: 10.1093/annonc/mdz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Little is known regarding sperm production following adjuvant treatment in testicular cancer (TC) clinical stage I (CS I) patients. PATIENTS AND METHODS A total of 182 TC patients aged 18-50 years were prospectively included during 2001-2006 at any given time within 5 years of orchiectomy. Semen samples were delivered postorchiectomy but before further treatment, 6, 12, 24, 36 and 60 months (T0-T60) after completed therapy. Total sperm number (TSN) and sperm concentration (SC) were used as measurements of testicular function. Four groups according to treatment modality were identified; Radiotherapy; To a total dose of 25.2 Gy to the infradiaphragmal paraaortic and ipsilateral iliac lymph nodes (RT, N = 70), one cycle of adjuvant BEP (bleomycin, etoposide, cisplatin, 5 day regimen) (BEP, N = 62), one cycle of adjuvant carboplatin AUC 7 (Carbo, N = 22), and patients managed by surveillance (SURV, N = 28). RESULTS In the cross-sectional analysis, a significant but transient drop in mean TSN and mean SC (T0-T60) was seen at T6 after radiotherapy. Apart from a significant increase in mean SC at T12 compared with baseline, no significant differences were observed in the other treatment groups. In 119 patients delivering 3 or more samples, values in TSN and SC were rather stable over time. Azoospermic patients (N = 11) were observed in most treatment groups except for in the BEP group. During follow-up, one azoospermic patient belonging to the Carbo group became normospermic. CONCLUSIONS No clinically significant long-term effect on TSN or SC associated with adjuvant treatment in TC CSI patients was found. However, as patients may have low sperm counts before orchiectomy as well as after adjuvant treatment, we offer sperm banking before orchiectomy as assisted reproductive measures may be necessary regardless of treatment given.
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Affiliation(s)
- K Weibring
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm.
| | - C Nord
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Lund
| | - K Sandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - H Johansson
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - S Arver
- Department of Medicine/Huddinge, Karolinska Institute, Stockholm; Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm
| | - A Giwercman
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
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Decision analysis defining optimal management of clinical stage 1 high-risk nonseminomatous germ cell testicular cancer with lymphovascular invasion. Urol Oncol 2018; 36:342.e1-342.e6. [PMID: 29754945 PMCID: PMC10182405 DOI: 10.1016/j.urolonc.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/22/2018] [Accepted: 03/30/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Risk of recurrent disease for men with clinical stage 1 high-risk nonseminomatous germ cell testicular cancer (CS1 NSGCT) with lymphovascular invasion (LVI) after orchiectomy is 50% and current treatment options (surveillance [S], retroperitoneal lymph node dissection [RPLND], or 1 cycle of BEP [BEP ×1]) are associated with a 99% disease specific survival, therefore practice patterns vary. We performed a decision analysis using updated data of long-term complications for men with CS1 NSGCT with LVI to quantify and assess relative treatment values. METHODS Decision analysis included previously defined utilities (via standard gamble) for posttreatment states of living from 0 (death from disease) to 1 (alive in perfect health) and updated morbidity probabilities. We quantified the values of S, RPLND, and BEP ×1 via the rollback method. Sensitivity analyses including a range of orchiectomy cure rates and utility values were performed. RESULTS Estimated probabilities favoring treatment with RPLND (0.97) or BEP ×1 (0.97) were equivalent and superior to surveillance (0.88). Sensitivity analysis of orchiectomy cure rates (50%-100%) failed to find a cure rate that favored S over BEP ×1 or RPLND. Varying utility values for cure after S from 0.92 (previously defined utility) to 1 (perfect health), failed to find a viable utility state favoring S over BEP ×1 or RPLND. An orchiectomy cure rate of ≥82% would be required for S to equal treatment of either type. CONCLUSIONS We demonstrate that for surveillance to be superior to treatment with BEP ×1 or RPLND, the orchiectomy cure rate must be at least 82%, which is not expected in a patient population with high-risk CS1 NSGCT.
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Ahluwalia P, Gautam G. Current Concepts in Management of Stage I NSGCT. Indian J Surg Oncol 2016; 8:51-58. [PMID: 28127183 DOI: 10.1007/s13193-016-0588-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022] Open
Abstract
While about 50% of non- seminomatous germ cell tumors of the testes present as clinical stage I (CSI), further management of these patients continues to be mired in controversy. Active surveillance is a frontline option for low- risk CS I patients and according to some, even the high- risk ones with high embryonal carcinoma (ECA) component and vascular invasion (VI). However, it carries the disadvantage of long- term surveillance, the need for prolonged chemotherapy in case of recurrence and the possibility of secondary malignancies due to radiation exposure from frequent CT scans. One or two cycles of BEP chemotherapy is a popular alternative to active surveillance which carries a very low relapse rate, but valid concerns about overtreatment of a majority of patients, with the attendant chemotherapy- related toxicity exist. Retroperitoneal lymph node dissection has been used as a means of avoiding chemotherapy, especially in high- risk patients, but carries the disadvantage of a high surgical morbidity and complications. As with any major surgical procedure, the best results are dependent on the experience and skill of the individual surgeon.
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Affiliation(s)
- Puneet Ahluwalia
- Division of Uro Oncology & Robotic Surgery, Department of Surgical Oncology, Max Institute of Cancer Care, Saket, New Delhi, India
| | - Gagan Gautam
- Division of Uro Oncology & Robotic Surgery, Department of Surgical Oncology, Max Institute of Cancer Care, Saket, New Delhi, India
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9
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Weiner AB, Pearce SM, Eggener SE. Management trends for men with early-stage nonseminomatous germ cell tumors of the testicle: An analysis of the National Cancer Database. Cancer 2016; 123:245-252. [DOI: 10.1002/cncr.30332] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/16/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Adam B. Weiner
- Pritzker School of Medicine; University of Chicago; Chicago Illinois
- Department of Urology; Northwestern University Feinberg School of Medicine; Chicago Illinois
| | - Shane M. Pearce
- Section of Urology, Department of Surgery; University of Chicago; Chicago Illinois
| | - Scott E. Eggener
- Section of Urology, Department of Surgery; University of Chicago; Chicago Illinois
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10
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Harada KI, Miyake H, Ogawa T, Inoue TA, Fujisawa M. Oncological Outcomes in Japanese Men Undergoing Orchiectomy for Stage I Testicular Germ Cell Tumor. Curr Urol 2016; 8:84-90. [PMID: 26889123 DOI: 10.1159/000365695] [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: 01/13/2014] [Accepted: 06/19/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objective of this study was to retrospectively review oncological outcomes in patients with stage I testicular germ cell tumor (GCT). PATIENTS AND METHODS This study included 265 consecutive Japanese men undergoing orchiectomy for stage I testicular GCT, and a retrospective review of their records was performed. RESULTS Of these 265 patients, 192 and 73 were pathologically classified with seminoma and nonseminoma, respectively. Prophylactic radiation and chemotherapy were performed in 62 patients with seminoma and 6 with nonseminoma, respectively. Disease recurrence occurred in 12 seminoma patients, of whom 11 had not received prophylactic radiation therapy; however, all 12 achieved a complete response to bleomycin, etoposide and cisplatin therapy. Of the nonseminoma patients, 19 experienced disease recurrence and were then treated with bleomycin, etoposide and cisplatin followed additionally by the surgical resection of residual tumors and salvage chemotherapy in 7 and 4, respectively. There was no cancer-specific death in the 265 patients, and 5-year recurrence-free survival rates in patients with seminoma and nonseminoma were 92.6 and 72.8%, respectively. Furthermore, following factors appeared to be significantly associated with recurrence-free survival in these patients: age, T classification, microvascular invasion and adjuvant therapy for those with seminoma, and microvascular invasion for those with nonseminoma. CONCLUSIONS Despite a generally favorable prognosis in Japanese men with stage I testicular GCT, intensive follow-up or prophylactic therapy should be considered for men with possible risk factors of disease recurrence.
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Affiliation(s)
- Ken-Ichi Harada
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideaki Miyake
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayoshi Ogawa
- Department of Urology, Himeji Red Cross Hospital, Himeji, Japan
| | - Taka-Aki Inoue
- Department of Urology, Hyogo Cancer Center, Akashi, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna MP, Nicolai N, Oldenburg J. Guidelines on Testicular Cancer: 2015 Update. Eur Urol 2015; 68:1054-68. [PMID: 26297604 DOI: 10.1016/j.eururo.2015.07.044] [Citation(s) in RCA: 448] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/18/2015] [Indexed: 11/16/2022]
Abstract
CONTEXT This is an update of the previous European Association of Urology testis cancer guidelines published in 2011, which included major changes in the diagnosis and treatment of germ cell tumours. OBJECTIVE To summarise latest developments in the treatment of this rare disease. Recommendations have been agreed within a multidisciplinary working group consisting of urologists, medical oncologists, and radiation oncologists. EVIDENCE ACQUISITION A semi-structured literature search up to February 2015 was performed to update the recommendations. In addition, this document was subjected to double-blind peer review before publication. EVIDENCE SYNTHESIS This publication focuses on the most important changes in treatment recommendations for clinical stage I disease and the updated recommendations for follow-up. CONCLUSIONS Most changes in the recommendations will lead to an overall reduction in treatment burden for patients with germ cell tumours. In advanced stages, treatment intensification is clearly defined to further improve overall survival rates. PATIENT SUMMARY This is an update of a previously published version of the European Association of Urology guidelines for testis cancer, and includes new recommendations for clinical stage I disease and revision of the follow-up recommendations. Patients should be fully informed of all the treatment options available to them.
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Affiliation(s)
- Peter Albers
- Department of Urology, Medical Faculty, Düsseldorf University, Düsseldorf, Germany.
| | | | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with section Pneumology, Universitätskliniken Eppendorf, Hamburg, Germany
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Karim Fizazi
- Department of Medicine, University of Paris XI, Villejuif, France
| | - Alan Horwich
- Academic Unit of Radiotherapy and Oncology, Royal Marsden NHS Trust and The Institute of Cancer Research, Sutton, UK
| | - Maria Pilar Laguna
- Department of Urology, Amsterdam Medical Centre, Amsterdam University, Amsterdam, The Netherlands
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jan Oldenburg
- Health Sciences, Høgskolen i Buskerud og Vestfold, Kongsberg, Norway
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Surveillance policy for Japanese patients with stage I testicular germ cell cancer in the multi-detector computed tomography era. Int J Clin Oncol 2015; 20:1198-202. [PMID: 25893862 DOI: 10.1007/s10147-015-0828-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The outcome of surveillance for Japanese patients with clinical stage I testicular germ cell cancer (GCC) was investigated in the multi-detector computed tomography (MDCT) era. METHODS The medical records of 92 Japanese patients with stage I GCC, who received treatment in our institution between March 1999 and February 2013, were reviewed. As six patients requested and received prophylactic chemotherapy and two patients seriously deviated from surveillance schedule, these patients were excluded from the study. Data from a total 84 patients were analyzed, RESULTS The median follow-up period following diagnosis was 5.1 years (inter-quartile range: IQR, 2.3-7.7 years). Of the 84 patients, eight (9.5 %) had a recurrence of their cancer in this observation period. Regarding histologic subtypes, the recurrence rates were five (9.3 %) of the 54 patients with seminoma and three (10 %) of the 30 patients with nonseminomatous germ cell tumor (NSGCT). All eight patients who experienced a recurrence did so within 2 years; they all underwent induction chemotherapy and remain alive at the time of writing, with no evidence of disease. Among 31 seminoma patients with a tumor more than 4 cm in size and rete testis invasion, cancer recurred in three (9.7 %) during the surveillance period. On the other hand, among the 13 patients with NSGCT and vascular invasion, three (23 %) experienced a recurrence, whereas the figure was zero for the 11 (0 %) patients without vascular invasion. CONCLUSION Fewer than 10 % of Japanese patients with stage I testicular GCC suffered a recurrence in the 5-year observation period of this study. The risk of occult disease, which will result in relapse, might be decreased in the MDCT era. All patients must be fully informed of the anticipated recurrence rate and the potential risks of exposure to chemotherapy agents.
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Oldenburg J, Cullen M, Tandstad T. Primum non nocere: do we harm stage I testicular cancer patients less by applying adjuvant chemotherapy than by failing to present this option? Ann Oncol 2015; 26:255-6. [DOI: 10.1093/annonc/mdu520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oldenburg J, Aparicio J, Beyer J, Cohn-Cedermark G, Cullen M, Gilligan T, De Giorgi U, De Santis M, de Wit R, Fosså SD, Germà-Lluch JR, Gillessen S, Haugnes HS, Honecker F, Horwich A, Lorch A, Ondruš D, Rosti G, Stephenson AJ, Tandstad T. Personalizing, not patronizing: the case for patient autonomy by unbiased presentation of management options in stage I testicular cancer. Ann Oncol 2014; 26:833-838. [PMID: 25378299 DOI: 10.1093/annonc/mdu514] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 10/28/2014] [Indexed: 11/12/2022] Open
Abstract
Testicular cancer (TC) is the most common neoplasm in males aged 15-40 years. The majority of patients have no evidence of metastases at diagnosis and thus have clinical stage I (CSI) disease [Oldenburg J, Fossa SD, Nuver J et al. Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24(Suppl 6): vi125-vi132; de Wit R, Fizazi K. Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006; 24: 5482-5492.]. Management of CSI TC is controversial and options include surveillance and active treatment. Different forms of adjuvant therapy exist, including either one or two cycles of carboplatin chemotherapy or radiotherapy for seminoma and either one or two cycles of cisplatin-based chemotherapy or retroperitoneal lymph node dissection for non-seminoma. Long-term disease-specific survival is ∼99% with any of these approaches, including surveillance. While surveillance allows most patients to avoid additional treatment, adjuvant therapy markedly lowers the relapse rate. Weighing the net benefits of surveillance against those of adjuvant treatment depends on prioritizing competing aims such as avoiding unnecessary treatment, avoiding more burdensome treatment with salvage chemotherapy and minimizing the anxiety, stress and life disruption associated with relapse. Unbiased information about the advantages and disadvantages of surveillance and adjuvant treatment is a prerequisite for informed consent by the patient. In a clinical scenario like CSI TC, where different disease-management options produce indistinguishable long-term survival rates, patient values, priorities and preferences should be taken into account. In this review, we provide an overview about risk factors for relapse, potential benefits and harms of adjuvant chemotherapy and active surveillance and a rationale for involving patients in individualized decision making about their treatment rather than adopting a uniform recommendation for all.
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Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Department of Oncology, University of Oslo, Oslo, Norway.
| | - J Aparicio
- Department of Oncology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J Beyer
- Department of Oncology, Universitätsspital Zürich, Zürich, Switzerland
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Cullen
- Department of Medical Oncology, Queen Elizabeth Hospital, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - T Gilligan
- Department of Solid Tumor Oncology, Cleveland Clinic, Cleveland, USA
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - M De Santis
- Kaiser Franz Josef Hospital and ACR-ITR and LBI-ACR Vienna-CTO, Vienna, Austria
| | - R de Wit
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S D Fosså
- Department of Oncology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - J R Germà-Lluch
- Department of Oncology, Institut Català d'Oncologia, Gran Via de l'Hospitalet Hospitalet de Llobregat, Barcelona, Spain
| | - S Gillessen
- Department of Medical Oncology, Kantonsspital, St Gallen, Switzerland
| | - H S Haugnes
- Oncology Department, University Hospital of North Norway, Tromsø, Norway
| | - F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland
| | - A Horwich
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - A Lorch
- Klinik für Urologie, konservative Uroonkologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - D Ondruš
- Department of Oncology, Comenius University Faculty of Medicine, St Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - G Rosti
- Medical Oncology, Ospedale Generale, Treviso, Italy
| | | | - T Tandstad
- The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway
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Isharwal S, Risk MC. Management of clinical stage I nonseminomatous germ cell tumors. Expert Rev Anticancer Ther 2014; 14:1021-32. [PMID: 24931909 DOI: 10.1586/14737140.2014.928593] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Therapeutic options for clinical stage I nonseminomatous germ cell tumor include active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND). Lymphovascular invasion (LVI) determines risk of recurrence, as those without LVI have 15% risk of relapse on surveillance while those with LVI have a 50% risk. This stratifies patients into high risk(LVI+) and low risk(LVI-) groups which direct treatment recommendations. Surveillance is preferred for those with low risk disease, and is an option for those with high risk disease, as at least half are over-treated with other options. Adjuvant chemotherapy is an option for all patients as it can eradicate micrometastatic disease and reduce recurrence by at least 90%. RPLND benefits patients with low volume retroperitoneal disease with a cure rate of RPLND alone at approximately 70%. All three treatment modalities have similar survival rates approaching 100% but differing potential morbidities, which, along with patient preferences and compliance, should guide treatment decisions.
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Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Krege S. [Diagnosis and treatment of nonseminomatous germ cell tumors]. Urologe A 2013; 52:1721-29; quiz 1730-2. [PMID: 24248533 DOI: 10.1007/s00120-013-3277-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Testicular cancer currently shows excellent rates of curing and even in advanced stages of disease about 70% can be achieved. This was possible due to continuously carrying out studies. To reduce long-term toxicity the focus is now put on reduction of treatment. In nonseminomatous germ cell cancer this is discussed especially for stage I disease where different therapeutic strategies can be offered. Concerning advanced disease the aim is a further improvement of treatment results. Polychemotherapy and surgical procedures are equally important in this scenario. Concerning residual tumor resection it should always be considered that the procedure can be extended by adjuvant surgery, e.g. cava resection. Therefore, those resections should only be performed at centers where all possibly needed surgical disciplines are available.
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Affiliation(s)
- S Krege
- Klinik für Urologie und Kinderurologie, Alexianer-Krankenhaus Maria-Hilf GmbH Krefeld, Dießemerbruch 81, 47805, Krefeld, Deutschland,
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Sosnowski R, Ligaj M. Precise pathological assessment plays a key role in proper patient management in nonseminoma germ cells tumor. Cent European J Urol 2013; 66:271-2. [PMID: 24707362 PMCID: PMC3974488 DOI: 10.5173/ceju.2013.03.art6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Roman Sosnowski
- Department of Urooncology, M. Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Marcin Ligaj
- Department of Pathology, M. Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna M. [EAU guidelines on testicular cancer: 2011 update. European Association of Urology]. Actas Urol Esp 2012; 36:127-45. [PMID: 22188753 DOI: 10.1016/j.acuro.2011.06.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account. TAKE HOME MESSAGE Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
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Maroto P, Garcí Del Muro X, Sastre J, Isla D. SEOM guidelines: non-seminomatous germ cell cancer (NSGCC). Clin Transl Oncol 2012; 13:565-8. [PMID: 21821491 DOI: 10.1007/s12094-011-0698-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Non-seminomatous germ cell cancer (NSGCC) is a curable disease; its treatment has not essentially changed since the 1980s. BEP (bleomycin, etoposide, cisplatin) chemotherapy remains the standard of care. NSGCC's management can be summarised by three trees of decision, which contemplate staging, treatment with chemotherapy and management of postchemotherapy residual disease. The role of high-dose chemotherapy remains to be established. TIP (paclitaxel, iposfamide, cisplatin) chemotherapy is still the standard salvage treatment for patients progressing after BEP chemotherapy. Surgical removal of any residual disease is mandatory. For patients with poor prognosis, consultation with a centre of expertise is strongly recommended.
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Affiliation(s)
- Pablo Maroto
- Servicio de Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
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Retroperitoneal Lymph Node Dissection for the Primary Treatment Recommendation in Clinical Stage I Nonseminomatous Germ Cell Tumors of the Testis: Contrary to European Guidelines. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.eursup.2011.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sturgeon JF, Moore MJ, Kakiashvili DM, Duran I, Anson-Cartwright LC, Berthold DR, Warde PR, Gospodarowicz MK, Alison RE, Liu J, Ma C, Pond GR, Jewett MA. Non–Risk-Adapted Surveillance in Clinical Stage I Nonseminomatous Germ Cell Tumors: The Princess Margaret Hospital’s Experience. Eur Urol 2011; 59:556-62. [DOI: 10.1016/j.eururo.2010.12.010] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 12/10/2010] [Indexed: 11/27/2022]
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Kollmannsberger C, Moore C, Chi KN, Murray N, Daneshmand S, Gleave M, Hayes-Lattin B, Nichols CR. Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors: diminishing treatment-related morbidity while maintaining efficacy. Ann Oncol 2010; 21:1296-1301. [PMID: 19875756 DOI: 10.1093/annonc/mdp473] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Kollmannsberger
- Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada
| | - C Moore
- Department of Medicine, Earle A. Chiles Research Institute, Providence Cancer Center
| | - K N Chi
- Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada
| | - N Murray
- Division of Medical Oncology, Department of Medicine, British Columbia Cancer Agency-Vancouver Cancer Center, Vancouver, British Columbia, Canada
| | - S Daneshmand
- Section of Urologic Oncology, Division of Urology and Renal Transplantation, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - M Gleave
- Department of Urological Sciences, University of British Columbia, The Prostate Center at Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - B Hayes-Lattin
- Division of Hematology and Medical Oncology, Department of Medicine, Oregon Health & Science University Knight Cancer Institute, Portland, OR, USA
| | - C R Nichols
- Department of Medicine, Earle A. Chiles Research Institute, Providence Cancer Center.
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Durand X, Avances C, Flechon A, Mottet N. Récidives tardives des tumeurs germinales du testicule. Prog Urol 2010; 20:416-24. [DOI: 10.1016/j.purol.2010.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 10/02/2009] [Accepted: 02/09/2010] [Indexed: 12/01/2022]
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Wood L, Kollmannsberger C, Jewett M, Chung P, Hotte S, O'Malley M, Sweet J, Anson-Cartwright L, Winquist E, North S, Tyldesley S, Sturgeon J, Gospodarowicz M, Segal R, Cheng T, Venner P, Moore M, Albers P, Huddart R, Nichols C, Warde P. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19-38. [PMID: 20368885 PMCID: PMC2845668 DOI: 10.5489/cuaj.815] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
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Zuniga A, Kakiashvili D, Jewett MAS. Surveillance in stage I nonseminomatous germ cell tumours of the testis. BJU Int 2009; 104:1351-6. [PMID: 19840012 DOI: 10.1111/j.1464-410x.2009.08858.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alvaro Zuniga
- Uro-Oncology Fellowship Program, Department of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- David J Vaughn
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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High-risk clinical stage I nonseminomatous germ cell tumors: the case for chemotherapy. World J Urol 2009; 27:455-61. [DOI: 10.1007/s00345-009-0456-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 07/14/2009] [Indexed: 11/25/2022] Open
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High risk NSGCT: case for surveillance. World J Urol 2009; 27:441-7. [DOI: 10.1007/s00345-009-0453-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/07/2009] [Indexed: 11/25/2022] Open
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Culine S, Mottet N, Rousmans S. Synthèse méthodique des données scientifiques 2007 : traitements de première intention des tumeurs germinales du testicule après orchidectomie totale. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis. Med Oncol 2008; 26:136-42. [PMID: 18821067 DOI: 10.1007/s12032-008-9095-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 09/11/2008] [Indexed: 10/21/2022]
Abstract
Testis cancer is the most common cancer in young men and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. We aimed to evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical stage I, non-seminomatous germ cell testicular tumour at high risk of relapse, will spare patients additional chemotherapy or surgery. High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dl, 80% embryonal cell carcinoma or greater, vessel invasion in the primary tumour and tumour stage pT2 or greater. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting cisplatin, etoposide and bleomycin (BEP). Low-risk patients were observed. Of the 108 patients, we classified 71 as high risk and 37 as low risk of relapse. All of the high-risk patients received two courses of BEP chemotherapy. Low-risk patients were kept on close-up. The median follow-up was 26 months (range 10-60). Of the 71 patients in high-risk group, 3 relapsed with viable cancer and required additional chemotherapy and 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lympadenectomy for mature teratoma. All 4 relapsed patients were in high-risk group and presently they are free of disease. None of the 37 patients at low risk of recurrences developed relapse. We recommend two courses of adjuvant chemotherapy after postorchiectomy for high-risk patients with stage I non-seminomatous germ cell tumour of the testis. Adjuvant chemotherapy for these patients results in a low relapse and morbidity, wich compares favourably with the results of surveillance or RPLND. This well-tolerated approach may spare patients additional surgery or protracted chemotherapy, reduce the cost and eliminate the compliance problems associated with intensive follow up of high-risk patients.
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Pectasides D, Pectasides E, Constantinidou A, Aravantinos G. Current management of stage I testicular non-seminomatous germ cell tumours. Crit Rev Oncol Hematol 2008; 70:114-23. [PMID: 18805019 DOI: 10.1016/j.critrevonc.2008.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 07/24/2008] [Accepted: 07/24/2008] [Indexed: 11/26/2022] Open
Abstract
Testicular germ cell tumors represent the most common malignancies in young males between the ages of 15 and 35; 50% of those with non-seminomatous germ cell tumors (NSGCT) have clinical stage I at diagnosis. Predictors for relapse include lymphovascular invasion, percentage of embryonal-cell carcinoma component, absence of yolk-sack histology and MIB1 proliferation rate. Therapeutic options following orchidectomy in stage I NSGCT comprise nerve-sparing retroperitoneal lymph node dissection (RPLND), surveillance or adjuvant cisplatin-based chemotherapy. Using a risk adapted approach, in about 50% of patients with clinical stage I NSGCT surveillance is favored in patients with good compliance. Adjuvant chemotherapy is recommended for patients at high risk for developing metastatic disease. Non-seminomatous germ cell testicular cancer is a curable neoplasia. All available treatment modalities produce excellent results, with a long-term survival of almost 100%. Consequently, therapy-induced toxicity is an important concern in the management of these patients. An individually tailored approach that takes into account the prognostic factor profile, as well as the patients' preferences and their ability to comply with treatment, is the key for the successful management of stage I testicular cancer.
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Affiliation(s)
- D Pectasides
- Second Department of Internal Medicine, Propaedeutic, Oncology Section, ATTIKON University General Hospital, Haidari, Athens, Greece.
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Yokoi K, Tanaka N, Furukawa K, Ishikawa N, Seya T, Horiba K, Kanazawa Y, Yamada T, Ohaki Y, Tajiri T. Male choriocarcinoma with metastasis to the jejunum: a case report and review of the literature. J NIPPON MED SCH 2008; 75:116-21. [PMID: 18475033 DOI: 10.1272/jnms.75.116] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report on a patient with male choriocarcinoma. The patient was a 31-year-old male patient with jejunal choriocarcinoma that metastasized from the mediastinum. He was admitted complaining of melena and severe anemia. Upper and lower gastrointestinal endosocopy was performed, but no source of bleeding was seen. Chest X-ray and CT revealed a mediastinal tumor 7 cm in size anterior to the arotic arch. Superior mesenteric arteriography showed irregularities and macular opacity in the jejunal artery. An emergency laparatomy was performed because of massive gastrointestinal bleeding. A jejunal tumor approximately 4 cm in size was resected and numerous metastases were observed in the liver and mesentery. Histopathological examination showed metastatic jejunal choriocarcinoma. Gynecomastia was not present and the testes were normal. Serum beta-human chorionic gonadotropin (HCG) was at an abnormally high level of 4,396 ng/mL. Because of metastases to the brain and invasion to the trachea, he died on postoperative day 20. We report this rare case of a male patient with metastases of choriocarcinoma to the gastrointestinal tract from the mediastinum, together with a review of the literature.
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Affiliation(s)
- Kimiyoshi Yokoi
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Japan.
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Albers P, Siener R, Krege S, Schmelz HU, Dieckmann KP, Heidenreich A, Kwasny P, Pechoel M, Lehmann J, Kliesch S, Köhrmann KU, Fimmers R, Weissbach L, Loy V, Wittekind C, Hartmann M. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol 2008; 26:2966-72. [PMID: 18458040 DOI: 10.1200/jco.2007.12.0899] [Citation(s) in RCA: 215] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Retroperitoneal lymph node dissection (RPLND) and adjuvant chemotherapy are two adjuvant treatment options for patients with clinical stage I nonseminomatous germ cell tumors of the testis (NSGCT). Aim of this trial was to prove the advantage of one cycle of bleomycin, etoposide, and cisplatin (BEP) chemotherapy compared with RPLND in terms of recurrence. PATIENTS AND METHODS Between 1996 and 2005, 382 patients were randomly assigned to receive either RPLND (n = 191) or one course of BEP (n = 191) after orchidectomy. The primary study end point was the rate of recurrence. The trial was powered to detect a 7% reduction (from 10% to 3%) of recurrence with chemotherapy compared with surgery. RESULTS After a median follow-up of 4.7 years, two and 15 recurrences were observed in the intention-to-treat population with chemotherapy and surgery, respectively (P = .0011). The difference in the 2-year recurrence-free survival rate between chemotherapy (99.46%; 95% CI, 96.20% to 99.92%) and surgery (91.87%; 95% CI, 86.87% to 95.02%) was 7.59% (95% CI, 3.13% to 12.05%). The hazard ratio to experience a tumor recurrence with surgery as opposed to chemotherapy was 7.937 (95% CI, 1.808 to 34.48). CONCLUSION To our knowledge, this is the largest randomized trial investigating adjuvant treatment strategies in clinical stage I NSGCT, which showed the superiority of one course BEP over RPLND performed according to community standards to prevent recurrence. Although not standard treatment, one course of BEP is active in an unselected group of patients with clinical stage I disease and merits further investigation.
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Affiliation(s)
- Peter Albers
- Department of Urology, Klinikum Kassel GmbH, Kassel, Germany.
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz-Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): Part II. Eur Urol 2008; 53:497-513. [PMID: 18191015 DOI: 10.1016/j.eururo.2007.12.025] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, Bamberg M, Bodrogi I, Bokemeyer C, Cavallin-Ståhl E, Classen J, Clemm C, Cohn-Cedermark G, Culine S, Daugaard G, De Mulder PH, De Santis M, de Wit M, de Wit R, Derigs HG, Dieckmann KP, Dieing A, Droz JP, Fenner M, Fizazi K, Flechon A, Fosså SD, Garcia del Muro X, Gauler T, Geczi L, Gerl A, Germa-Lluch JR, Gillessen S, Hartmann JT, Hartmann M, Heidenreich A, Hoeltl W, Horwich A, Huddart R, Jewett M, Joffe J, Jones WG, Kisbenedek L, Klepp O, Kliesch S, Koehrmann KU, Kollmannsberger C, Kuczyk M, Laguna P, Leiva Galvis O, Loy V, Mason MD, Mead GM, Mueller R, Nichols C, Nicolai N, Oliver T, Ondrus D, Oosterhof GO, Paz Ares L, Pizzocaro G, Pont J, Pottek T, Powles T, Rick O, Rosti G, Salvioni R, Scheiderbauer J, Schmelz HU, Schmidberger H, Schmoll HJ, Schrader M, Sedlmayer F, Skakkebaek NE, Sohaib A, Tjulandin S, Warde P, Weinknecht S, Weissbach L, Wittekind C, Winter E, Wood L, von der Maase H. European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I. Eur Urol 2008; 53:478-96. [PMID: 18191324 DOI: 10.1016/j.eururo.2007.12.024] [Citation(s) in RCA: 330] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Mottet N, Culine S, Iborra F, Avances C, Bastide C, Lesourd A, Michel F, Rigaud J. Tumeurs du Testicule. Prog Urol 2007; 17:1035-45. [DOI: 10.1016/s1166-7087(07)74779-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sava T, Consoli F, Santo A, Cetto GL. Adjuvant treatment in the management of testis-confined germ cell tumours after orchidectomy. BJU Int 2007; 101:155-9. [PMID: 17662077 DOI: 10.1111/j.1464-410x.2007.07080.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Germ cell tumours are highly curable, especially when still at the localized stage, which is the case for most testicular tumours. Various options are available for organ-confined disease; depending on the histological review, patients with clinical stage I seminomas can be offered radiotherapy, surveillance or chemotherapy, whereas those with clinical stage I nonseminomas can be offered retroperitoneal lymph node dissection, surveillance or chemotherapy. As it is unlikely that any of these approaches will have a clear survival advantage, the most appropriate variables to be considered are acute and late side-effects, acceptability and quality of life. In recent years adjuvant chemotherapy has been extensively evaluated in patients with seminoma or nonseminoma. In this review we discuss the advantages and disadvantages of the different strategies for treating seminomas and nonseminomas, and their associated prognostic factors, and then consider future developments.
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Affiliation(s)
- Teodoro Sava
- Department of Medical Oncology, University of Verona, Italy.
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Albers P. Management of Stage I Testis Cancer. Eur Urol 2007; 51:34-43; discussion 43-4. [PMID: 16996677 DOI: 10.1016/j.eururo.2006.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2006] [Accepted: 08/02/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Over the last 5 years the management of stage I testis cancer has changed tremendously. This review focuses on the latest changes in diagnostics and treatment of clinical stage I non-seminomatous and seminomatous germ cell tumors. METHODS A non-structured literature search (MEDLINE) was performed, including recently published papers (up to March 2006) on the subject. RESULTS Organ-sparing surgery has become an accepted approach to treat malignant and nonmalignant tumours in a solitary testis. With certain precautions and adjuvant radiotherapy, this approach has proven to be as effective as orchidectomy. Prognostic factors strongly influence the decision for or against adjuvant treatment in seminoma and non-seminoma. With the help of a risk-adapted approach, about 50% of patients with clinical stage I testis cancer will favour close surveillance instead of immediate adjuvant treatment. Several well-conducted trials have helped to substantiate the management. Surgical staging by retroperitoneal lymph node dissection became an exception. Patients with non-seminoma with high risk for occult metastatic disease will favour adjuvant chemotherapy and in patients with seminoma radiotherapy with reduced dosage will be challenged by carboplatin monotherapy. CONCLUSION With adequate diagnostics and treatment, 100% of patients with stage I testis cancer will survive. Future research will focus on quality control, adherence to guideline recommendations, and further reduction of treatment to diminish the risk of late sequalae for patients with adjuvant radiotherapy or chemotherapy.
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Affiliation(s)
- Peter Albers
- Department of Urology, Klinikum Kassel GmbH, D-34125, Kassel, Germany.
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Oldenburg J, Martin JM, Fosså SD. Late Relapses of Germ Cell Malignancies: Incidence, Management, and Prognosis. J Clin Oncol 2006; 24:5503-11. [PMID: 17158535 DOI: 10.1200/jco.2006.08.1836] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Late relapses of malignant germ cell tumors (MGCTs) are rare and occur, by definition, 2 years or later after successful treatment. They represent a major challenge of today's treatment of MGCTs. Because of the rarity and heterogeneity of late relapses, many aspects of their main characteristics remain obscure. We present relevant literature on relapsing MGCTs to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival. In a pooled analysis, the incidence is 1.4% and 3.2% in seminoma and nonseminoma patients, respectively. The predominant site of relapse is the retroperitoneal space in both histologic types. The initial treatment appears to be important for the risk and localization of late relapses. The treatment of late relapses should be based on a representative presalvage biopsy and includes radical surgery and salvage chemotherapy in most cases. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single-site teratoma. Diagnosis and treatment of late-relapsing MGCT patients is challenging and should be performed in experienced centers only. Referral of late-relapsing patients to high-volume institutions ensures the best chances of cure and enables increasing understanding of tumor biology and the clinical course of these patients.
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Affiliation(s)
- Jan Oldenburg
- Department of Clinical Cancer Research, University of Oslo, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
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