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Tapia JC, Gavira J, Anguera G, Sanchez S, Romano A, Bosma F, Molina A, Sanz-Beltran J, Martin-Lorente C, Algaba F, Maroto P. Cumulative incidences of hypogonadism, hypertension, and dyslipidaemia in patients with stage I seminoma treated with a risk-adapted strategy: a Spanish single-centre retrospective analysis. Clin Transl Oncol 2024:10.1007/s12094-024-03393-9. [PMID: 38421563 DOI: 10.1007/s12094-024-03393-9] [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: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To describe the incidences of hypogonadism, hypertension, and dyslipidaemia in patients with stage 1 seminoma (S1S) testicular cancer (TC) treated with a risk-adapted strategy. METHODS A retrospective analysis from 2000 to 2020 was conducted. Active surveillance (AS), carboplatin one cycle, and carboplatin two cycles were offered according to risk factors. Cumulative incidences and relapse-free survival (RFS) were estimated. RESULTS Of the 145 patients, 8 (5.4%) were excluded due to bilateral TC or hypogonadism at diagnosis. Median follow-up time was 8.2 years. Eighty-four, 30, and 33 patients were treated with AS, carboplatin one cycle, and carboplatin two cycles, respectively. In the overall population, the 5-year and 10-year cumulative incidences were 1.6% and 5.3% for hypogonadism; 2.0% and 8.6% for hypertension; and 12.4% and 25.1% for dyslipidaemia. No statistically significant differences were found in the incidences among the three adjuvant strategies. Five-year and 10-year RFS were 85.9% and 83.3% for AS; 92.4% and 84.0% for carboplatin one cycle; and 96.7% at both times for carboplatin two cycles. CONCLUSION There were no statistically differences in cumulative incidences of hypogonadism, hypertension, and dyslipidaemia in S1S patients treated with a risk-adapted strategy.
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Affiliation(s)
- Jose C Tapia
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain.
| | - Javier Gavira
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Georgia Anguera
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sofia Sanchez
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Alejandra Romano
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Freya Bosma
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Alejandra Molina
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Judit Sanz-Beltran
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Cristina Martin-Lorente
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Fernando Algaba
- Pathology Department, Fundació Puigvert, Cartagena 340, 08025, Barcelona, Spain
| | - Pablo Maroto
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
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2
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Nuñez-Corona D, Contreras-Sanzón E, Puente-Rivera J, Arreola R, Camacho-Nuez M, Cruz Santiago J, Estrella-Parra EA, Torres-Romero JC, López-Camarillo C, Alvarez-Sánchez ME. Epigenetic Factors and ncRNAs in Testicular Cancer. Int J Mol Sci 2023; 24:12194. [PMID: 37569569 PMCID: PMC10418327 DOI: 10.3390/ijms241512194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Testicular cancer is the most prevalent tumor among males aged 15 to 35, resulting in a significant number of newly diagnosed cases and fatalities annually. Non-coding RNAs (ncRNAs) have emerged as key regulators in various cellular processes and pathologies, including testicular cancer. Their involvement in gene regulation, coding, decoding, and overall gene expression control suggests their potential as targets for alternative treatment approaches for this type of cancer. Furthermore, epigenetic modifications, such as histone modifications, DNA methylation, and the regulation by microRNA (miRNA), have been implicated in testicular tumor progression and treatment response. Epigenetics may also offer critical insights for prognostic evaluation and targeted therapies in patients with testicular germ cell tumors (TGCT). This comprehensive review aims to present the latest discoveries regarding the involvement of some proteins and ncRNAs, mainly miRNAs and lncRNA, in the epigenetic aspect of testicular cancer, emphasizing their relevance in pathogenesis and their potential, given the fact that their specific expression holds promise for prognostic evaluation and targeted therapies.
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Affiliation(s)
- David Nuñez-Corona
- Posgrado en Ciencias Genómicas, Universidad Autónoma De México (UACM), San Lorenzo 290, Col. Del Valle, México City 03100, Mexico
| | - Estefania Contreras-Sanzón
- Posgrado en Ciencias Genómicas, Universidad Autónoma De México (UACM), San Lorenzo 290, Col. Del Valle, México City 03100, Mexico
| | | | - Rodrigo Arreola
- Departamento De Genética, Instituto Nacional De Psiquiatría “Ramón De la Fuente Muñiz”, Calz. Mexico, Xochimilco 101, Col. Huipulco, Tlalpan, México City 14370, Mexico
| | - Minerva Camacho-Nuez
- Posgrado en Ciencias Genómicas, Universidad Autónoma De México (UACM), San Lorenzo 290, Col. Del Valle, México City 03100, Mexico
| | - José Cruz Santiago
- Hospital De Especialidades Centro Médico Nacional La Raza, IMSS, México City 02990, Mexico
| | - Edgar Antonio Estrella-Parra
- Laboratorio De Fitoquímica, UBIPRO, FES-Iztacala, Unidad Nacional Autónoma de México, Av. De los Barrios No.1, Los Reyes Iztacala, Tlalnepantla 54090, Mexico
| | - Julio César Torres-Romero
- Laboratorio De Bioquímica y Genética Molecular, Facultad De Química, Universidad Autónoma De Yucatán, Calle 43 s/n x Calle 96, Paseo De las Fuentes y 40, Col. Inalambrica, Yucatán 97069, Mexico
| | - César López-Camarillo
- Posgrado en Ciencias Genómicas, Universidad Autónoma De México (UACM), San Lorenzo 290, Col. Del Valle, México City 03100, Mexico
| | - María Elizbeth Alvarez-Sánchez
- Posgrado en Ciencias Genómicas, Universidad Autónoma De México (UACM), San Lorenzo 290, Col. Del Valle, México City 03100, Mexico
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3
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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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4
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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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5
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Kaufmann E, Antonelli L, Albers P, Cary C, Gillessen Sommer S, Heidenreich A, Oing C, Oldenburg J, Pierorazio PM, Stephenson AJ, Fankhauser CD. Oncological Follow-up Strategies for Testicular Germ Cell Tumours: A Narrative Review. EUR UROL SUPPL 2022; 44:142-149. [PMID: 36106144 PMCID: PMC9465095 DOI: 10.1016/j.euros.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Luca Antonelli
- Department of Urology, Luzerner Kantonssspital, Lucerne, Switzerland
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Silke Gillessen Sommer
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biosciences, USI University, Lugano, Switzerland
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Christoph Oing
- Sir Bobby Robson Cancer Trials Research Centre, Department of Cancer Services, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway
| | - Phillip Martin Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christian Daniel Fankhauser
- University of Zurich, Zurich, Switzerland
- Department of Urology, Luzerner Kantonssspital, Lucerne, Switzerland
- Corresponding author. Department of Urology, Luzerner Kantonsspital, Spitalstrasse 6000, 16 Lucerne, Switzerland.
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6
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Tilsed CM, Fisher SA, Nowak AK, Lake RA, Lesterhuis WJ. Cancer chemotherapy: insights into cellular and tumor microenvironmental mechanisms of action. Front Oncol 2022; 12:960317. [PMID: 35965519 PMCID: PMC9372369 DOI: 10.3389/fonc.2022.960317] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/01/2022] [Indexed: 12/12/2022] Open
Abstract
Chemotherapy has historically been the mainstay of cancer treatment, but our understanding of what drives a successful therapeutic response remains limited. The diverse response of cancer patients to chemotherapy has been attributed principally to differences in the proliferation rate of the tumor cells, but there is actually very little experimental data supporting this hypothesis. Instead, other mechanisms at the cellular level and the composition of the tumor microenvironment appear to drive chemotherapy sensitivity. In particular, the immune system is a critical determinant of chemotherapy response with the depletion or knock-out of key immune cell populations or immunological mediators completely abrogating the benefits of chemotherapy in pre-clinical models. In this perspective, we review the literature regarding the known mechanisms of action of cytotoxic chemotherapy agents and the determinants of response to chemotherapy from the level of individual cells to the composition of the tumor microenvironment. We then summarize current work toward the development of dynamic biomarkers for response and propose a model for a chemotherapy sensitive tumor microenvironment.
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Affiliation(s)
- Caitlin M. Tilsed
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Nedlands, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Scott A. Fisher
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Nedlands, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Anna K. Nowak
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Nedlands, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Richard A. Lake
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Nedlands, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - W. Joost Lesterhuis
- National Centre for Asbestos Related Diseases, Institute for Respiratory Health, Nedlands, WA, Australia
- School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, University of Western Australia, West Perth, WA, Australia
- *Correspondence: W. Joost Lesterhuis,
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7
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Papachristofilou A, Zimmermann F. [Malignant testicular neoplasms in the cisplatin era: causes of death and mortality in a cohort study]. Strahlenther Onkol 2022; 198:862-865. [PMID: 35581422 DOI: 10.1007/s00066-022-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandros Papachristofilou
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - Frank Zimmermann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
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8
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Pulzová LB, Roška J, Kalman M, Kliment J, Slávik P, Smolková B, Goffa E, Jurkovičová D, Kulcsár Ľ, Lešková K, Bujdák P, Mego M, Bhide MR, Plank L, Chovanec M. Screening for the Key Proteins Associated with Rete Testis Invasion in Clinical Stage I Seminoma via Label-Free Quantitative Mass Spectrometry. Cancers (Basel) 2021; 13:cancers13215573. [PMID: 34771736 PMCID: PMC8583098 DOI: 10.3390/cancers13215573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/12/2022] Open
Abstract
Rete testis invasion (RTI) is an unfavourable prognostic factor for the risk of relapse in clinical stage I (CS I) seminoma patients. Notably, no evidence of difference in the proteome of RTI-positive vs. -negative CS I seminomas has been reported yet. Here, a quantitative proteomic approach was used to investigate RTI-associated proteins. 64 proteins were differentially expressed in RTI-positive compared to -negative CS I seminomas. Of them, 14-3-3γ, ezrin, filamin A, Parkinsonism-associated deglycase 7 (PARK7), vimentin and vinculin, were validated in CS I seminoma patient cohort. As shown by multivariate analysis controlling for clinical confounders, PARK7 and filamin A expression lowered the risk of RTI, while 14-3-3γ expression increased it. Therefore, we suggest that in real clinical biopsy specimens, the expression level of these proteins may reflect prognosis in CS I seminoma patients.
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Affiliation(s)
- Lucia Borszéková Pulzová
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
| | - Jan Roška
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
| | - Michal Kalman
- Department of Pathological Anatomy, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University, Malá Hora 4A, 036 01 Martin, Slovakia; (M.K.); (P.S.); (K.L.); (L.P.)
| | - Ján Kliment
- Clinic of Urology, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University, Malá Hora 4A, 036 01 Martin, Slovakia;
| | - Pavol Slávik
- Department of Pathological Anatomy, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University, Malá Hora 4A, 036 01 Martin, Slovakia; (M.K.); (P.S.); (K.L.); (L.P.)
| | - Božena Smolková
- Biomedical Research Center, Department of Molecular Oncology, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia;
| | - Eduard Goffa
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
| | - Dana Jurkovičová
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
| | - Ľudovít Kulcsár
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
| | - Katarína Lešková
- Department of Pathological Anatomy, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University, Malá Hora 4A, 036 01 Martin, Slovakia; (M.K.); (P.S.); (K.L.); (L.P.)
| | - Peter Bujdák
- Department of Urology, Faculty of Medicine, Comenius University, 813 72 Bratislava, Slovakia;
| | - Michal Mego
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Klenová 1, 833 10 Bratislava, Slovakia
| | - Mangesh R. Bhide
- Department of Microbiology and Immunology, University of Veterinary Medicine, Komenského 73, 041 81 Košice, Slovakia;
- Institute of Neuroimmunology, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia
| | - Lukáš Plank
- Department of Pathological Anatomy, Jessenius Faculty of Medicine and University Hospital in Martin, Comenius University, Malá Hora 4A, 036 01 Martin, Slovakia; (M.K.); (P.S.); (K.L.); (L.P.)
| | - Miroslav Chovanec
- Biomedical Research Center, Department of Genetics, Cancer Research Institute, Slovak Academy of Sciences, Dúbravská cesta 9, 845 05 Bratislava, Slovakia; (L.B.P.); (J.R.); (E.G.); (D.J.); (Ľ.K.); (M.M.)
- Correspondence:
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9
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Nason GJ, Chung P, Warde P, Huddart R, Albers P, Kollmannsberger C, Booth CM, Hansen AR, Bedard PL, Einhorn L, Nichols C, Rendon RA, Wood LA, Jewett MAS, Hamilton RJ. Controversies in the management of clinical stage 1 testis cancer. Can Urol Assoc J 2020; 14:E537-E542. [PMID: 32569575 DOI: 10.5489/cuaj.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawrence Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori A Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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10
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Aparicio J, García Del Muro X, Maroto P, Terrasa J, Castellano D, Bastús R, Gumà J, Sagastibeltza N, Durán I, Ochenduszko S, Meana JA, García-Sánchez J, Arranz JA, Gironés R, Germà JR. Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group. Clin Transl Oncol 2020; 23:58-64. [PMID: 32462393 DOI: 10.1007/s12094-020-02393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. METHODS We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. RESULTS No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. CONCLUSION In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.
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Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
| | - X García Del Muro
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - P Maroto
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Terrasa
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - D Castellano
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Bastús
- Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - J Gumà
- Hospital Universitari Sant Joan, URV, IISPV, Reus, Spain
| | | | - I Durán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Ochenduszko
- Hospital Universitario Doctor Peset, Valencia, Spain
| | - J A Meana
- Hospital General Universitario, Alicante, Spain
| | | | - J A Arranz
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Gironés
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain
| | - J R Germà
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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11
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Orillard E, Klajer E, Kalbacher E, Joly F, David A, Hervé L, Viot J, Mouillet G, Barkatz J, Kleinclauss F, Thiery-Vuillemin A. [Relapse surveillance of patients with testicular germ cell tumor]. Bull Cancer 2019; 106:903-914. [PMID: 31495441 DOI: 10.1016/j.bulcan.2019.06.006] [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: 01/20/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Germ-cell tumors are the most common solid tumors in young men. The follow-up of these patients is very important in their management. In stage I testicular cancer, surveillance is the standard for low-risk disease. In addition to the early detection of relapse, follow-up should be directed towards prevention, detection and treatment of late toxicity, and secondary malignancies. Follow up consists in physical examination, laboratory analysis and radiological imaging. Recently, guidelines recommend risk-adapted surveillance strategy, with a reduction of CT scans numbers, due to the recognition of the risk of ionizing radiation exposure. However, efforts to maintain adequate compliance with follow up are required.
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Affiliation(s)
| | - Elodie Klajer
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | - Elsa Kalbacher
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | - Florence Joly
- Inserm, U1086, UNICANCER, centre François Baclesse, Clinical Research Department and Medical Department, 14076 Caen, France
| | - Alina David
- CHU de Besançon, radiologie, 25030 Besançon cedex, France
| | - Laure Hervé
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | - Julien Viot
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | | | | | - François Kleinclauss
- Inserm, UMR1098, 25020 Besançon cedex, France; Université de Franche-Comté, UMR1098, SFR IBCT, 25020 Besançon, France; CHU de Besançon, urologie, 25030 Besançon cedex, France
| | - Antoine Thiery-Vuillemin
- CHU de Besançon, oncologie, 25030 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France; Université de Franche-Comté, UMR1098, SFR IBCT, 25020 Besançon, France
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13
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Adjuvant carboplatin therapy in patients with clinical stage 1 testicular seminoma: is long-term morbidity increased? J Cancer Res Clin Oncol 2019; 145:2335-2342. [DOI: 10.1007/s00432-019-02965-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
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14
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Recommendations for surveillance and follow-up of men with testicular germ cell tumors: a multidisciplinary consensus conference by the Italian Germ cell cancer Group and the Associazione Italiana di Oncologia Medica. Crit Rev Oncol Hematol 2019; 137:154-164. [PMID: 31014511 DOI: 10.1016/j.critrevonc.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND No compelling evidence is available about surveillance and follow-up of patients with testicular germ cell tumour (TGCT). METHODS In the light of the best clinical evidence, the Italian Germ cell cancer Group (IGG) and the Associazione Italiana di Oncologia Medica (AIOM) set up a multidisciplinary national consensus conference, involving 42 leading experts and 3 TGCT survivors. A minimum of 50% of votes was required in order to achieve a consensus recommendation on 29 questions. RESULTS Recommendations have been summarized in three tables, divided by stage I seminoma, stage I nonseminoma and the advanced disease, which may be useful for clinicians to appropriately choose the clinical investigation and its timing during the surveillance and follow-up of TGCT patients based on an accurate estimation of their risk of disease relapse. CONCLUSIONS The IGG-AIOM consensus recommendations may help clinicians to choose appropriate clinical investigations for the surveillance and follow-up of TGCT patients.
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Intermediate and long-term complications associated with adjuvant chemotherapy for stage I germ cell tumor patients. Curr Opin Urol 2018; 28:485-490. [DOI: 10.1097/mou.0000000000000527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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16
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Non–risk-adapted Surveillance for Stage I Testicular Cancer: Critical Review and Summary. Eur Urol 2018; 73:899-907. [DOI: 10.1016/j.eururo.2017.12.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/27/2017] [Indexed: 11/22/2022]
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Fehr M, Maranta AF, Reichegger H, Gillessen S, Cathomas R. Carboplatin dose based on actual renal function: no excess of acute haematotoxicity in adjuvant treatment in seminoma stage I. ESMO Open 2018. [PMID: 29531843 PMCID: PMC5844370 DOI: 10.1136/esmoopen-2018-000320] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction The practice of carboplatin dosing is not concordant among different centres and oncologists. Some clinical guidelines recommend capping of the carboplatin dose at, for example, creatinine-clearance (Crea-Cl) of 125 mL/min because of concerns of excessive toxicity. Clinical data to support such recommendations are lacking, especially in patients with seminoma. Methods This is a retrospective analysis of acute haematotoxicity of patients with stage I seminoma treated with adjuvant carboplatin area under the curve (AUC) 7 in routine practice in two Swiss centres in 2005–2015, and a comparison of incidence and grade (according to Common Terminology Criteria for Adverse Events v4.0) of haematological adverse events (hAEs) in patients with Crea-Cl <125 mL/min vs >125 mL/min without dose capping. Results 74 patients with 229 documented measurements were included (median 3/patient). A total of 151 hAEs occurred. Platelet nadir occurred earlier than median white cell/neutrophil count (median day 15 vs day 22; P<0.0001). The majority of hAEs were mild, with more than 80% being of grade 1. Only two (2.7%) clinically relevant hAEs necessitating subsequent interventions occurred (one patient received platelet transfusion, one patient with febrile neutropaenia). Haematological toxicities were not statistically different in patients dosed with Crea-Cl >125 mL/min versus those with Crea-Cl <125 mL/min. No hAEs other than grade 1 occurred before day 10 and after day 24. Conclusions Toxicity after single-dose carboplatin AUC 7 is generally mild. No excess of toxicity occurs in patients with high Crea-Cl above 125 mL/min, and therefore dose capping is not routinely necessary. In addition, this study provides a rationale for efficient use of healthcare services without compromising patients’ safety.
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Affiliation(s)
- Martin Fehr
- Clinic for Medical Oncology and Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Hermann Reichegger
- Clinic for Medical Oncology and Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Silke Gillessen
- Clinic for Medical Oncology and Haematology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Richard Cathomas
- Department of Oncology/Haematology, Cantonal Hospital Grisons, Chur, Switzerland
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Siracusano S, Diminutto A, Porcaro AB, Cerruto MA, Artibani W. Use of AUC7 adjuvant carboplatin in patients with stage I seminoma: systematic review of the literature. TUMORI JOURNAL 2018; 104:83-87. [PMID: 27791233 DOI: 10.5301/tj.5000577] [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] [Indexed: 11/20/2022]
Abstract
PURPOSE Among the adjuvant options to be proposed to patients with stage I seminoma after orchiectomy, the administration of a single cycle of carboplatin, at the dosage reaching an area under the curve of 7 mg/mL/min (AUC7), is a relatively recent introduction in clinical practice. METHODS On April 1, 2016, we performed a systematic review of the literature to identify studies on the use of AUC7 carboplatin in the adjuvant setting for stage I seminoma patients. The studies were identified by searching the PubMed electronic database from July 2005 up to April 2016. The aim of this review is to clarify the state of art of this adjuvant option. RESULTS Adjuvant AUC7 carboplatin is an effective adjuvant treatment, able to reduce relapse rate in stage I seminoma patients. The heterogeneity of the methods for estimation and measurement of glomerular filtration rate represents an important issue in the administration of the optimal dose of carboplatin. Even with the lack of validated prognostic factors for relapses, a risk-adapted choice is commonly used to identify the optimal patient to be proposed this treatment. CONCLUSIONS One cycle of AUC7 carboplatin is an effective, feasible, and safe adjuvant option to be discussed with stage I seminoma patients.
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Affiliation(s)
- Salvatore Siracusano
- Department of Urology, University of Verona, Ospedale Borgo Trento, Verona - Italy
| | - Alberto Diminutto
- Department of Urology, University of Verona, Ospedale Borgo Trento, Verona - Italy
| | | | - Maria Angela Cerruto
- Department of Urology, University of Verona, Ospedale Borgo Trento, Verona - Italy
| | - Walter Artibani
- Department of Urology, University of Verona, Ospedale Borgo Trento, Verona - Italy
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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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Boormans JL, Mayor de Castro J, Marconi L, Yuan Y, Laguna Pes MP, Bokemeyer C, Nicolai N, Algaba F, Oldenburg J, Albers P. Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel. Eur Urol 2017; 73:394-405. [PMID: 29100813 DOI: 10.1016/j.eururo.2017.09.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
CONTEXT Patients with clinical stage I (CS I) seminoma testis with large primary tumours and/or rete testis invasion (RTI) might have an increased risk of relapse. In recent years, these risk factors have frequently been employed to decide on adjuvant treatment. OBJECTIVE To systematically review the literature on tumour size and RTI as risk factors for relapse in CS I seminoma testis patients under surveillance. EVIDENCE ACQUISITION Relevant databases including Medline, Embase, and the Cochrane Library were searched up to November 2016. Randomised controlled trials (RCTs) or quasi-RCTs, prospective observational studies with controls, retrospective matched-pair studies, and comparative studies from well-defined registries/databases were included. The primary outcome was the rate of relapse and relapse-free survival (RFS). The risk of bias was assessed by the Quality in Prognosis Studies tool. EVIDENCE SYNTHESIS After assessing 3068 abstracts and 80 full-text articles, 20 studies met the inclusion criteria. Although evidence to justify a cut-off of 4cm for size was lacking, it was the most frequently studied. The reported hazard ratio (HR) for the RFS for tumours >4cm was 1.59-2.8. Accordingly, the reported 5-yr RFS ranged from 86.6% to 95.5% and from 73.0% to 82.6% for patients having tumours ≤4 and >4cm, respectively. For tumours with RTI present, the reported HR was 1.4-1.7. The 5-yr RFS ranged from 86.0% to 92.0% and 74.9% to 79.5% for patients without versus those with RTI present, respectively. A meta-analysis was considered inappropriate due to data heterogeneity. CONCLUSIONS Primary tumour size and RTI are associated with the risk of relapse in CS I seminoma testis patients during surveillance. However, in the presence of either risk factor, the vast majority of patients are cured by orchiectomy alone and will not relapse. Furthermore, the evidence on the prognostic value of size and RTI has significant limitations, so prudency is warranted on their routine use in clinical practice. PATIENT SUMMARY Primary testicular tumour size and rete testis invasion are considered to be important prognostic factors for the risk of relapse in patients with clinical stage I seminoma testis. We systematically reviewed all the literature on the prognostic value of these two postulated risk factors. The outcome is that the prognostic power of these factors in the published literature is too low to advocate their routine use in clinical practice and to drive the choice on adjuvant treatment in clinical stage I seminoma testis patients.
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Affiliation(s)
- Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | | | - Lorenzo Marconi
- Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Yuhong Yuan
- Division of Gastroenterology and Cochrane UGPD Group, Department of Medicine, Health Sciences Centre, McMaster University, Hamilton, Canada
| | - M Pilar Laguna Pes
- Department of Urology, AMC University Hospital Amsterdam, The Netherlands
| | - Carsten Bokemeyer
- Department of Internal Medicine II, Oncology, Hematology and Stem Cell Transplantation with Section Pneumology, University Hospital Eppendorf, Hamburg, Germany
| | - Nicola Nicolai
- Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Ferran Algaba
- Department of Pathology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway and University of Oslo, Oslo, Norway
| | - Peter Albers
- Department of Urology, Düsseldorf University Hospital, Heinrich-Heine-University Düsseldorf, Germany
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Boulos S, Mazhar D, Warren AY, Wong HH. Adjuvant chemotherapy and follow-up for recurrences in localized testicular cancer. Future Oncol 2017; 13:947-950. [PMID: 28481147 DOI: 10.2217/fon-2017-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Suliman Boulos
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Danish Mazhar
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Anne Y Warren
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Han Hsi Wong
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
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Spiller CM, Bowles J. Germ cell neoplasia in situ: The precursor cell for invasive germ cell tumors of the testis. Int J Biochem Cell Biol 2017; 86:22-25. [DOI: 10.1016/j.biocel.2017.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
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Fischer S, Tandstad T, Wheater M, Porfiri E, Fléchon A, Aparicio J, Klingbiel D, Skrbinc B, Basso U, Shamash J, Lorch A, Dieckmann KP, Cohn-Cedermark G, Ståhl O, Chau C, Arriola E, Marti K, Hutton P, Laguerre B, Maroto P, Beyer J, Gillessen S. Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma. J Clin Oncol 2017; 35:194-200. [DOI: 10.1200/jco.2016.69.0958] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Adjuvant carboplatin is one of three management strategies that may follow inguinal orchiectomy in clinical stage I seminoma. However, little is known about the outcome of patients who experience a relapse after such treatment. Patients and Methods Data from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 centers/groups from 20 countries were collected and retrospectively analyzed. Primary outcomes were disease-free survival and overall survival. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. Results With a median follow-up of 53 months (95% CI, 48 to 60 months) the 5-year disease-free survival was 82% (95% CI, 77% to 89%), and the 5-year overall survival was 98% (95% CI, 95% to 100%). The median time from orchiectomy to relapse was 19 months (95% CI, 17 to 23 months); 15% (95% CI, 10% to 21%) of relapses occurred > 3 years after treatment. The majority of relapses were detected by computed tomography scan during routine follow-up, 98% in the International Germ Cell Cancer Collaborative Group good prognosis group. Chemotherapy was administered to 92% of patients, mostly as standard first-line treatment corresponding to stage; 8% of patients had additional local treatments. Only 28 patients experienced a second relapse. At last follow-up, 174 (94%) of 185 patients were alive without disease, and four patients with disease. Seven patients died, three of whom due to progressive disease. Conclusion Within the limitations of a retrospective analysis, the results suggest that the majority of patients who experience a relapse after adjuvant carboplatin for clinical stage I seminoma can be successfully treated with a cisplatin-based chemotherapy regimen adequate for stage. Because 15% of the relapses occurred > 3 years after adjuvant treatment, a minimum of 5 years follow-up is recommended.
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Affiliation(s)
- Stefanie Fischer
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Torgrim Tandstad
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Matthew Wheater
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Emilio Porfiri
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Aude Fléchon
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Jorge Aparicio
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Dirk Klingbiel
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Breda Skrbinc
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Umberto Basso
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Jonathan Shamash
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Anja Lorch
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Klaus-Peter Dieckmann
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Gabriella Cohn-Cedermark
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Olof Ståhl
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Caroline Chau
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Edurne Arriola
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Kalena Marti
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Paul Hutton
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Brigitte Laguerre
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Pablo Maroto
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Jörg Beyer
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
| | - Silke Gillessen
- Stefanie Fischer and Silke Gillessen, Cantonal Hospital St Gallen, St Gallen; Dirk Klingbiel, SAKK Coordinating Center, Bern; Jörg Beyer, Universitätsspital Zürich, Zürich, Switzerland; Torgrim Tandstad, St Olavs University Hospital, Trondheim, Norway; Matthew Wheater, Caroline Chau, and Edurne Arriola, University Hospital Southampton, Southampton; Emilio Porfiri, Kalena Marti, and Paul Hutton, Birmingham University Hospital, Birmingham; Jonathan Shamash, St Bartholomew’s Hospital, London, United
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Mortensen MS, Bandak M, Kier MGG, Lauritsen J, Agerbaek M, Holm NV, von der Maase H, Daugaard G. Surveillance versus adjuvant radiotherapy for patients with high-risk stage I seminoma. Cancer 2016; 123:1212-1218. [DOI: 10.1002/cncr.30458] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Mette S. Mortensen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mikkel Bandak
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Maria G. G. Kier
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
- Unit of Survivorship; Danish Cancer Society Research Center, Danish Cancer Society; Copenhagen Denmark
| | - Jakob Lauritsen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mads Agerbaek
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Niels V. Holm
- Department of Oncology; Odense University Hospital; Odense Denmark
| | - Hans von der Maase
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Gedske Daugaard
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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Tandstad T, Ståhl O, Dahl O, Haugnes H, Håkansson U, Karlsdottir Å, Kjellman A, Langberg C, Laurell A, Oldenburg J, Solberg A, Söderström K, Stierner U, Cavallin-Ståhl E, Wahlqvist R, Wall N, Cohn-Cedermark G. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol 2016; 27:1299-304. [DOI: 10.1093/annonc/mdw164] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
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Dieckmann KP, Anheuser P. The challenge to one-course carboplatin in seminoma clinical stage 1. Ann Oncol 2016; 27:1648-9. [PMID: 27154420 DOI: 10.1093/annonc/mdw187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K-P Dieckmann
- Department of Urology, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | - P Anheuser
- Department of Urology, Albertinen-Krankenhaus Hamburg, Hamburg, Germany
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Ondrusova M, Balogova S, Lehotska V, Kajo K, Mrinakova B, Ondrus D. Controversies in the management of clinical stage I testicular seminoma. Cent European J Urol 2016; 69:35-9. [PMID: 27123323 PMCID: PMC4846723 DOI: 10.5173/ceju.2016.699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 10/21/2015] [Accepted: 12/11/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Following orchiectomy patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (AS) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, mainly second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as adjuvant therapy for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches – AS versus adjuvant chemotherapy (ACT) on survival in patients with CSI testicular seminoma. Material and methods The cross-sectional study analyzed a total of 106 patients collected at a single centre between 4/2008–8/2015, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches. Results In group A (low-risk), consisting of 84 patients, who underwent AS, relapse occurred in 10 (11.9%) patients after a mean follow-up of 13.8 months. In group B (high-risk), consisting of 22 patients, who were treated with ACT, relapse occurred in two (9.1%) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100% with a mean follow-up of 25.3 months. The statistically significant difference in progression-free survival (PFS) between these two groups was not found. Conclusions ACT seems to be adequate treatment for patients with high-risk of relapse, as well as AS for those with low-risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.
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Affiliation(s)
- Martina Ondrusova
- St. Elisabeth University of Health and Social Sciences, Bratislava, Slovak Republic; Cancer Research Institute, Slovak Academy of Sciences, Bratislava, Slovak Republic; Pharm-In, Ltd., Bratislava, Slovak Republic
| | - Sona Balogova
- Department of Nuclear Medicine, Comenius University, Faculty of Medicine & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - Viera Lehotska
- 2 Department of Radiology, Comenius University, Faculty of Medicine & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - Karol Kajo
- Department of Pathology, Slovak Medical University & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - Bela Mrinakova
- Department of Medical Oncology & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic
| | - Dalibor Ondrus
- 1 Department of Oncology, Comenius University, Faculty of Medicine & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic
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Testicular seminoma clinical stage 1: treatment outcome on a routine care level. J Cancer Res Clin Oncol 2016; 142:1599-607. [PMID: 27116691 PMCID: PMC4899489 DOI: 10.1007/s00432-016-2162-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/11/2016] [Indexed: 11/29/2022]
Abstract
Purpose Clinical stage 1 (CS1) testicular seminoma involves an almost 100 % disease-specific survival in controlled clinical trials. We aimed to find out whether these results can be matched in patients managed on the routine care level. Patients, methods In total, 725 patients with seminoma CS1 were prospectively enrolled from 130 institutions. Adjuvant management as decided by local physicians involved surveillance (n = 256), radiotherapy (41), 1× Carboplatin (362), and 2× Carboplatin (66). We registered type of management, age, duration of follow-up (F/U), relapse, rete testis invasion (RTI), and tumor size. Actuarial relapse-free survival curves were calculated for treatment modalities and stratified for tumor sizes and RTI. A Cox regression model was calculated to explore for factors influencing relapses. Results Disease-specific survival was 100 %. Crude relapse rates were 8.2, 2.4, 5.0, and 1.5 % for surveillance, radiotherapy, 1× Carboplatin, and 2× Carboplatin after a median F/U of 30 months. RTI and tumor size were not associated with progression in surveillance patients. One course Carboplatin caused relapses in 6.8 % in tumor sizes >4 cm and 9.3 % (actuarial 13 %) in sizes >5 cm. The Cox model revealed the association of tumor size with recurrence in the entire seminoma population (Hazard ratio 1.17; 95 % confidence intervals 1.03–1.33). Conclusions The overall outcome of CS1 seminoma managed on the routine care level mirrors that of controlled trials. Unexpectedly, the risk factors in surveillance patients were not confirmed, but tumor size proved to be a risk indicator in the entire group of seminoma. Importantly, one course Carboplatin involved low efficacy to control the disease in large tumors. Electronic supplementary material The online version of this article (doi:10.1007/s00432-016-2162-z) contains supplementary material, which is available to authorized users.
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Abstract
Testicular germ cell tumours are at the crossroads of developmental and neoplastic processes. Their cause has not been fully elucidated but differences in incidences suggest that a combination of genetic and environment factors are involved, with environmental factors predominating early in life. Substantial progress has been made in understanding genetic susceptibility in the past 5 years on the basis of the results of large genome-wide association studies. Testicular germ cell tumours are highly sensitive to radiotherapy and chemotherapy and hence have among the best outcomes of all tumours. Because the tumours occur mainly in young men, preservation of reproductive function, quality of life after treatment, and late effects are crucial concerns. In this Seminar, we provide an overview of advances in the understanding of the epidemiology, genetics, and biology of testicular germ cell tumours. We also summarise the consensus on how to treat testicular germ cell tumours and focus on a few controversies and improvements in the understanding of late effects of treatment and quality of life for survivors.
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Affiliation(s)
- Ewa Rajpert-De Meyts
- Department of Growth and Reproduction, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark; International Center for Research and Research Training in Endocrine Disrupting Effects on Male Reproduction and Child Health, Copenhagen, Denmark
| | - Katherine A McGlynn
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Keisei Okamoto
- Department of Urology, Shiga University of Medical Science, Tsukinowa, Seta, Shiga, Japan.
| | - Michael A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Carsten Bokemeyer
- Department of Oncology, Haematology, Bone Marrow Transplantation with section Pneumology, Department of Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Oing C, Seidel C, von Amsberg G, Oechsle K, Bokemeyer C. Pharmacotherapeutic treatment of germ cell tumors: standard of care and recent developments. Expert Opin Pharmacother 2015; 17:545-60. [DOI: 10.1517/14656566.2016.1127357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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