1
|
Małkiewicz B, Świrkosz G, Lewandowski W, Demska K, Szczepaniak Z, Karwacki J, Krajewski W, Szydełko T. Lymph Node Dissection in Testicular Cancer: The State of the Art and Future Perspectives. Curr Oncol Rep 2024; 26:318-335. [PMID: 38430323 PMCID: PMC11021343 DOI: 10.1007/s11912-024-01511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW This narrative review provides a comprehensive overview of the evolving role of retroperitoneal lymph node dissection (RPLND) in the management of testicular cancer (TC). It explores the significance of RPLND as both a diagnostic and therapeutic tool, highlighting its contribution to accurate staging, its impact on oncological outcomes, and its influence on subsequent treatment decisions. RECENT FINDINGS RPLND serves as an essential diagnostic procedure, aiding in the precise assessment of lymph node involvement and guiding personalized treatment strategies. It has demonstrated therapeutic value, particularly in patients with specific risk factors and disease stages, contributing to improved oncological outcomes and survival rates. Recent studies have emphasized the importance of meticulous patient selection and nerve-sparing techniques to mitigate complications while optimizing outcomes. Additionally, modern imaging and surgical approaches have expanded the potential applications of RPLND. In the context of TC management, RPLND remains a valuable and evolving tool. Its dual role in staging and therapy underscores its relevance in contemporary urological practice. This review highlights the critical role of RPLND in enhancing patient care and shaping treatment strategies, emphasizing the need for further research to refine patient selection and surgical techniques.
Collapse
Affiliation(s)
- Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
| | - Gabriela Świrkosz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Lewandowski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Katarzyna Demska
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Zuzanna Szczepaniak
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland.
| | - Jakub Karwacki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| |
Collapse
|
2
|
Grange R, Rousset P, Williet N, Guesnon M, Milot L, Passot G, Phelip JM, Le Roy B, Glehen O, Kepenekian V. Metastatic Colorectal Cancer Treated with Combined Liver Resection, Cytoreductive Surgery, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): Predictive Factors for Early Recurrence. Ann Surg Oncol 2024; 31:2378-2390. [PMID: 38170409 DOI: 10.1245/s10434-023-14840-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Selection of colorectal cancer patients with concomitant peritoneal (PM) and liver metastases (LM) for radical treatment with cytoreductive surgery (CRS), including liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), needs improvement. This retrospective, monocentric study was designed to evaluate the predictive factors for early recurrence, disease-free survival (DFS), and overall survival (OS) in such patients treated in a referral center. METHODS Consecutive colorectal cancer patients with concomitant LM and PM treated with curative intent with perioperative systemic chemotherapy, simultaneous complete CRS, liver resection, and HIPEC in 2011-2022 were included. Clinical, radiological (before and after preoperative chemotherapy), surgical, and pathological data were investigated, along with long-term oncologic outcomes. A multivariate analysis was performed to identify predictive factors associated with early recurrence (diagnosed <6 months after surgery), DFS, and OS. RESULTS Of more than 61 patients included, 31 (47.1%) had pT4 and 27 (40.9%) had pN2 primary tumors. Before preoperative chemotherapy, the median number of LM was 2 (1-4). The median surgical PCI (peritoneal carcinomatosis index) was 3 (5-8.5). The median DFS and OS were 8.15 (95% confidence interval [CI] 5.5-10.1) and 34.1 months (95% CI 28.1-53.5), respectively. In multivariate analysis, pT4 (odds ratio [OR] = 4.14 [1.2-16.78], p = 0.032]) and pN2 (OR = 3.7 [1.08-13.86], p = 0.042) status were independently associated with an early recurrence, whereas retroperitoneal lymph node metastasis (hazard ratio [HR] = 39 [8.67-175.44], p < 0.001) was independently associated with poor OS. CONCLUSIONS In colorectal cancer patients with concomitant PM and LM, an advanced primary tumor (pT4 and/or pN2) was associated with a higher risk of early recurrence following a radical multimodal treatment, whereas RLN metastases was strongly detrimental for OS.
Collapse
Affiliation(s)
- Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Pascal Rousset
- Department of Radiology, CHU Lyon Sud, Hospices Civils de Lyon, CICLY EMR 3738, Lyon 1 University, Pierre Bénite, France
| | - Nicolas Williet
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Mathias Guesnon
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France
- CICLY, EMR 3738, Lyon 1 University, Lyon, France
| | - Laurent Milot
- Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Guillaume Passot
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France
- CICLY, EMR 3738, Lyon 1 University, Lyon, France
| | - Jean-Marc Phelip
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Bertrand Le Roy
- Department of Digestive and Oncologic Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Olivier Glehen
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France
- CICLY, EMR 3738, Lyon 1 University, Lyon, France
| | - Vahan Kepenekian
- Department of General Surgery and Surgical Oncology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre, Bénite, France.
- CICLY, EMR 3738, Lyon 1 University, Lyon, France.
| |
Collapse
|
3
|
Gereta S, Hung M, Hu JC. Robotic-assisted retroperitoneal lymph node dissection for testicular cancer. Curr Opin Urol 2023; 33:274-280. [PMID: 37014761 DOI: 10.1097/mou.0000000000001094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Robotic-assisted retroperitoneal lymph node dissection (R-RPLND) is an emerging surgical option for testicular cancer with less morbidity than open RPLND. We outline the operative technique used at our center and review contemporary evidence in the advancement of R-RPLND. RECENT FINDINGS R-RPLND is being applied effectively beyond clinical stage I testicular cancer to treat low-volume, clinical stage II disease in both the primary and postchemotherapy setting. Compared with the open approach, R-RPLND offers shorter hospitalization and less blood loss with comparably low complications and oncologic control. SUMMARY With ongoing adoption and optimization of R-RPLND, future studies will assess long-term oncologic outcomes and disseminate R-RPLND in the treatment of testicular cancer.
Collapse
Affiliation(s)
- Sofia Gereta
- Department of Surgery & Perioperative Care, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Michael Hung
- Department of Urology, New York-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| | - Jim C Hu
- Department of Urology, New York-Presbyterian Weill Cornell Medical Center, New York, New York, USA
| |
Collapse
|
4
|
Behr GG, Morani AC, Artunduaga M, Desoky SM, Epelman M, Friedman J, Lala SV, Seekins J, Towbin AJ, Back SJ. Imaging of pediatric testicular tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29988. [PMID: 36184829 PMCID: PMC10646825 DOI: 10.1002/pbc.29988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
Primary intratesticular tumors are uncommon in children, but incidence and risk of malignancy both sharply increase during adolescence. Ultrasound is the mainstay for imaging the primary lesion, and cross-sectional modalities are often required for evaluation of regional or distant disease. However, variations to this approach are dictated by additional clinical and imaging nuances. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary testicular malignancy at diagnosis and during follow-up.
Collapse
Affiliation(s)
- Gerald G Behr
- Memorial Sloan Kettering Cancer Center/Weill Cornell Medicine, New York, New York, USA
| | | | | | - Sarah M Desoky
- University of Arizona College of Medicine, Tucson, Arizona, USA
| | | | | | - Shailee V Lala
- New York University Langone Health, New York, New York, USA
| | - Jayne Seekins
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, California, USA
| | | | - Susan J Back
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
5
|
Vasiliadis K, Simou C, Tzotzou A, Kalinderis N, Valoukas D, Pazarli E, Drakontaidis P, Papavasiliou C. Successful surgical management of massive hemoretroperitoneum caused by spontaneous rupture of retroperitoneal lymph node metastases in a patient with advanced mixed germ cell tumor: a COVID-19 pandemic-related surgical challenge. Surg Case Rep 2023; 9:18. [PMID: 36740640 PMCID: PMC9899871 DOI: 10.1186/s40792-023-01593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/19/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Spontaneous rapture of a germ cell tumor (GCT) metastases causing massive hemoretroperitoneum in a patient without choriocarcinoma component who has not received previous systemic chemotherapy is an exceedingly rare event. In such a devastating case scenario, a high index of clinical suspicion for early diagnosis and appropriate management is crucial. CASE PRESENTATION We report on a 25-year-old male patient with a 4-month history of orchiectomy for testicular GCT (tGCT), who presented in the emergency department with acute abdomen and hemodynamic instability. Urgent computed tomography scan depicted a retroperitoneal mass measuring approximately 13 × 11.4 × 15 cm and massive intraperitoneal hemorrhage. Hemoperitoneum caused by spontaneous rapture of the metastatic retroperitoneal mass was suspected. COVID-19 pandemic-related deviation from the oncologic surveillance standards combined with COVID-19-related patient's emotional distress and self-neglect had led to loss of opportunity for appropriate adjuvant chemotherapy, obviously leading to the development of this devastating complication. An emergency, surgical exploration was decided. The bleeding mass was adequately exposed following a Cattell-Braasch maneuver and active bleeding was controlled by a challenging resection of approximately 80% of the lymph node mass volume. Pathological evaluation of the specimen revealed teratoma with low volume of yolk sac tumor component and extensive necrosis, findings compatible with the patient's history. Postoperative recovery was uneventful, followed by early start of adjuvant chemotherapy. Two years after the operation the patient is doing well with no evidence of recurrent disease. CONCLUSIONS Massive hemoperitoneum is a devastating event that exceedingly rarely can complicate the clinical course of patients with advanced tGCT. Emergency surgical intervention is usually necessary however, sound judgement and careful surgical techniques are required for a positive and uneventful outcome. During COVID-19 pandemic, first-line medical personnel push their limits further not only to ensure health care services standards but also, to manage unpredictable, life-threatening cancer-related complications, associated with COVID-19-related deviation from appropriate oncologic surveillance and care.
Collapse
Affiliation(s)
- Konstantinos Vasiliadis
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Chrysanthi Simou
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tzotzou
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Kalinderis
- grid.4793.900000001094570052Nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Valoukas
- grid.4793.90000000109457005Department of Medical Oncology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elsa Pazarli
- grid.417144.3Department of Pathology, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Paulos Drakontaidis
- grid.417144.3Radiology Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Papavasiliou
- grid.417144.3Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
6
|
The Role of CT in the Staging and Follow-Up of Testicular Tumors: Baseline, Recurrence and Pitfalls. Cancers (Basel) 2022; 14:cancers14163965. [PMID: 36010958 PMCID: PMC9406011 DOI: 10.3390/cancers14163965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Testicular cancer (TC) is an uncommon group of tumors affecting predominantly younger males between 15 and 40 years, and accounting for less than 1% of malignancies in men, albeit in the context of an increasing incidence rate over recent decades. Testicular germ cell tumors (TGCT) are the most frequent (90%), and most cases of TGCT are organ-confined at diagnosis. The majority of patients with TGCT have an excellent prognosis, with a 5-year survival rate greater than 95%, and expect to be cured thanks to different risk-adapted treatments such as cisplatin-based chemotherapy, even at advanced stages. It is for this reason that both initial staging and follow-up are essential for appropriate management in initiating adapted therapy as well as treating cases of recurrence, most frequent during the first 5 years. Abstract Ultrasound imaging of the testis represents the standard-of-care initial imaging for the diagnosis of TGCT, whereas computed tomography (CT) plays an integral role in the initial accurate disease staging (organ-confined, regional lymph nodes, or sites of distant metastases), in monitoring the response to therapy in patients who initially present with non-confined disease, in planning surgical approaches for residual masses, in conducting follow-up surveillance and in determining the extent of recurrence in patients who relapse after treatment completion. CT imaging has also an important place in diagnosing complications of treatments. The aims of this article are to review these different roles of CT in primary TGCT and focus on different pitfalls that radiologists need to be aware of.
Collapse
|
7
|
Magnetic Fields and Cancer: Epidemiology, Cellular Biology, and Theranostics. Int J Mol Sci 2022; 23:ijms23031339. [PMID: 35163262 PMCID: PMC8835851 DOI: 10.3390/ijms23031339] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/22/2022] [Accepted: 01/22/2022] [Indexed: 02/08/2023] Open
Abstract
Humans are exposed to a complex mix of man-made electric and magnetic fields (MFs) at many different frequencies, at home and at work. Epidemiological studies indicate that there is a positive relationship between residential/domestic and occupational exposure to extremely low frequency electromagnetic fields and some types of cancer, although some other studies indicate no relationship. In this review, after an introduction on the MF definition and a description of natural/anthropogenic sources, the epidemiology of residential/domestic and occupational exposure to MFs and cancer is reviewed, with reference to leukemia, brain, and breast cancer. The in vivo and in vitro effects of MFs on cancer are reviewed considering both human and animal cells, with particular reference to the involvement of reactive oxygen species (ROS). MF application on cancer diagnostic and therapy (theranostic) are also reviewed by describing the use of different magnetic resonance imaging (MRI) applications for the detection of several cancers. Finally, the use of magnetic nanoparticles is described in terms of treatment of cancer by nanomedical applications for the precise delivery of anticancer drugs, nanosurgery by magnetomechanic methods, and selective killing of cancer cells by magnetic hyperthermia. The supplementary tables provide quantitative data and methodologies in epidemiological and cell biology studies. Although scientists do not generally agree that there is a cause-effect relationship between exposure to MF and cancer, MFs might not be the direct cause of cancer but may contribute to produce ROS and generate oxidative stress, which could trigger or enhance the expression of oncogenes.
Collapse
|
8
|
Davila Dupont D, Motola Kuba D, Alcantara Velarde TDLM, Martinez Castaneda EA, Dorantes Heredia R, Ruiz Morales JM. Impact of Testicular Germ Cell Tumor Laterality on Recurrence-Free Survival in the Mexican Population. World J Oncol 2021; 12:173-177. [PMID: 34804280 PMCID: PMC8577600 DOI: 10.14740/wjon1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, the prognostic value of laterality for testicular germ cell tumors remains unknown. Herein, we describe this prognostic factor in the Mexican population. Methods A retrospective single-center study that included 37 patients with primary testicular germ cell tumors was conducted. Primary outcome was recurrence-free survival (RFS) at 2 years. Secondary outcomes were RFS by histology, progression-free survival by laterality, and 2-year overall survival. Results Thirty-seven patients were included, of which five showed relapses. By laterality, the 2-year RFS rate was 100% for left tumors and 77.3% for right tumors, with a trend toward statistical significance (P = 0.058). By histology, the RFS rate was higher for seminomas than non-seminomas (89% vs. 83%, respectively) without this difference being statistically significant. Progression-free survival was higher for right tumors than left tumors (91% vs. 80%, respectively) but without reaching statistical significance. The overall survival rate for the entire cohort was 94.5%. Conclusions Our study shows that patients with primary germ cell tumors of the right testicle have a higher risk of recurrence than those with primary germ cell tumors of the left testicle, with a trend toward statistical significance.
Collapse
|
9
|
Magnetic resonance versus computed tomography for the detection of retroperitoneal lymph node metastasis due to testicular cancer: A systematic literature review. Eur J Radiol Open 2021; 8:100372. [PMID: 34458506 PMCID: PMC8377546 DOI: 10.1016/j.ejro.2021.100372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION It is essential to see if MRI can be used as an alternative to CT for the detection of retroperitoneal lymphadenopathy in patients with testicular neoplasms. By doing so, the amount of radiation received by these young patients might be reduced. MATERIAL AND METHODS A systematic literature review was carried out in 5 databases between January 1984 until December 2020. The articles included were randomized and non-randomized clinical trials, cross-sectional studies, cohort, case and control, and retrospective studies that compare the accuracy of MRI against CT to detect retroperitoneal lymph nodes in patients with testicular neoplasms. RESULTS The search string initially retrieved 222 non duplicated papers from which a total of 3 studies of diagnostic accuracy were included for analysis. These articles evaluated a total of 127 patients with testicular neoplasm; the sample size per study ranged from 25 to 52 patients, with a mean age between 29-34 years. MRI presented a sensitivity ranging from 98-80% and specificity of 100 % when read by an experienced radiologist. However, when it was read by a radiologist with 1 year of experience, the sensitivity dropped to 78 % and specificity to 91%. CONCLUSION This systematic literature review shows a knowledge gap since not much has been published regarding this topic; therefore, randomized clinical trials are mandatory. Research on when to use MRI over CT is necessary to reduce radiation exposure. The authors strongly suggest that readers start researching on this subject.
Collapse
Key Words
- CT, computed tomography
- ESMO, European Society for Medical Oncology
- LNMRI, lymphotropic nanoparticle enhanced MRI
- Lymph node
- Lymphatic metastasis
- MRI, magnetic resonance imaging
- Magnetic resonance imaging
- NPV, negative predictive value
- PPV, positive predictive value
- PRISMA, the preferred reporting items for systematic review and meta-analysis
- QUADAS-2, quality assessment of diagnostic accuracy studies-2
- SWENOTECA, Swedish-Norwegian Testicular Cancer Project
- TRISST, trial of imaging and schedule in seminoma of the testis
- Testicular neoplasms
- Tomography X-ray computed
Collapse
|
10
|
Thomson A, Keong B, Longano A, Hamid A, Sengupta S. Testicular seminoma metastases presenting as gastrointestinal malignancy: A case report and review of the literature. ANZ J Surg 2021; 92:271-273. [PMID: 34137494 DOI: 10.1111/ans.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Alice Thomson
- Department of Urology, Eastern Health, Box Hill, Victoria, Australia
| | - Ben Keong
- Department of General Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Anthony Longano
- Department of Anatomical Pathology, Eastern Health, Box Hill, Victoria, Australia
| | - Anis Hamid
- Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Shomik Sengupta
- Department of Urology, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| |
Collapse
|
11
|
Unenhanced MRI of the abdomen and pelvis for surveillance of patients with stage 1 testicular cancer post-radical orchiectomy. Abdom Radiol (NY) 2021; 46:1157-1162. [PMID: 32901295 DOI: 10.1007/s00261-020-02715-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the ability of unenhanced magnetic resonance imaging (MRI) to detect metastatic lymphadenopathy in men with stage 1 testicular cancer on surveillance. MATERIALS AND METHODS With IRB approval, we identified 23 consecutive men with stage 1 testicular cancer (diagnosed after orchiectomy) undergoing surveillance with unenhanced MRI of the abdomen and pelvis. Three blinded radiologists (2 inexperienced R1/R2 and 1 experienced R3) independently assessed MRI for: presence, location and size of abnormal lymph nodes and degree of confidence (5-point Likert scale) in diagnosis. Diagnostic accuracy was tabulated and compared between groups using ROC. Inter-observer agreement was assessed using Cohen's kappa statistic. RESULTS 17.4% (4/23) men developed 6 metastatic lymph nodes (reference standard: interval development from baseline, size > 1.0 cm short axis). R1 and R2 detected 75% (3/4) patients with abnormal lymph nodes, compared to R3 who detected all four cases. False positive interpretations occurred in: 5.2% (1/19) R1, 10.5% (2/19) R2 and no patients for R3. Sensitivity, specificity and area under the ROC curve (AUC) were: R1: 75% (95% CI 19.4-99.4%), 94.7% (74.0-99.9%) and 0.85 (0.59-1.00), R2: 75% (19.4-99.4%), 89.5% (66.9-98.7%) and 0.82 (0.57-1.00) and, R3: 100% (95% 39.8-100.0%), 100% (82.4-100%) and 1.00 (1.00-1.00) with no difference in AUC between readers (p = 0.383). Comparison in accuracy between readers is limited due to the small sample size. Inter-observer agreement was substantial (K = 0.62). Median (range) degree of confidence scores were rated: R1 5 (5-5), R2 4 (3-5) and, R3 5 (5-5). CONCLUSION In this study, unenhanced MRI was adequate for surveillance of stage 1 testicular cancer; however, radiologist inexperience may lead to errors.
Collapse
|
12
|
Rizzo M, Ongaro L, Claps F, Ghassempour D, Verzotti E, Migliozzi F, Boltri M, Pavan N, Garaffa G, Bucci S, Umari P, Trombetta C, Liguori G. Analysis of clinical utility of abdominopelvic computed tomography in the follow-up of Stage I seminoma: a single center evaluation. Minerva Urol Nephrol 2021; 73:84-89. [PMID: 31833335 DOI: 10.23736/s2724-6051.19.03562-8] [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: 11/08/2022]
Abstract
BACKGROUND Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma. METHODS The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging. RESULTS Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.
Collapse
Affiliation(s)
- Michele Rizzo
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy -
| | - Luca Ongaro
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Dario Ghassempour
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Enrica Verzotti
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesca Migliozzi
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Stefano Bucci
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Paolo Umari
- Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy
| | - Carlo Trombetta
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| |
Collapse
|
13
|
Clinical Performance of Abbreviated Liver MRI for the Follow-Up of Patients With Colorectal Liver Metastases. AJR Am J Roentgenol 2021; 216:669-676. [PMID: 33502225 DOI: 10.2214/ajr.20.22854] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The objective of our study was to compare an abbreviated liver MRI protocol with a standard liver MRI protocol for the posttreatment follow-up of colorectal metastases in assessing disease presence, segmental involvement, and response to chemotherapy and for surgical planning. MATERIALS AND METHODS. This retrospective single-center study reviewed consecutive chemotherapy-naïve patients with colorectal liver metastases (April 1, 2011-August 31, 2017) who underwent gadoxetate disodium-enhanced MRI on a 1.5-T unit before and 8-12 weeks after chemotherapy. Two radiologists blinded to outcomes independently reviewed images obtained using standard MRI sequences at baseline and after treatment. The standard MRI sequences were the following: axial T1-weighted, axial T2-weighted, axial DWI (b values = 0-750 s/mm2), axial multiphase contrast-enhanced T1-weighted, and axial and coronal hepatobiliary phase (HBP) T1-weighted sequences. The standard sequences obtained at baseline and the abbreviated protocol sequences (i.e., HBP gadoxetate disodium-enhanced T1-weighted and DWI sequences) obtained after treatment were reviewed. For each image set, reviewers assessed disease presence and segmental involvement; in addition, for images obtained after therapy, treatment response according to RECIST 1.1 was recorded. RESULTS. One hundred thirteen patients (73 men and 40 women; mean age, 61.6 years) were evaluated. The total number of metastases showed high agreement between the standard protocol and abbreviated protocol (intraclass correlation coefficient = 0.97). There was good agreement between the protocols for segmental involvement (weighted κ = 0.73-0.85), and the weighted kappa was 0.82 for all segments. Discrepancies in segmental involvement did not alter potential surgical planning. Categorization of RECIST 1.1 treatment response using the abbreviated protocol versus the standard protocol showed excellent agreement (weighted κ = 0.92). CONCLUSION. An abbreviated liver MRI protocol (i.e., HBP gadoxetate disodium-enhanced T1-weighted and DWI sequences) allows assessment after chemotherapy similar to a standard liver MRI protocol. Use of the abbreviated protocol can reduce imaging time without sacrificing diagnostic performance for the follow-up of colorectal liver metastases.
Collapse
|
14
|
Dotzauer R, Salamat A, Nabar ND, Thomas A, Böhm K, Brandt MP, Mager R, Borgmann H, Kurosch M, Hoefner T, Tsaur I, Hötker AM, Haferkamp A, Jäger W. The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making. Minerva Urol Nephrol 2021; 74:72-76. [PMID: 33439568 DOI: 10.23736/s2724-6051.20.03877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI-abdomen. It has not been investigated so far whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial staging and occurrence of unspecific lymph node enlargement and adjuvant therapies after inguinal orchiectomy. METHODS We retrospectively evaluated clinical and radiological data from 236 patients who had undergone inguinal orchiectomy for testicular cancer at our department. Statistical analysis was performed to determine whether the occurrence of unspecific lymph node enlargement or the rate of adjuvant therapies were influenced by timing of initial staging (preoperative vs. postoperative). RESULTS The postoperative imaging cohort showed significant more inguinal, pelvic and retroperitoneal unspecific lymph node enlargement than the preoperative imaging cohort. Simultaneous occurrence of inguinal or pelvic lymph node enlargement together with retroperitoneal enlargements could only be found in the postoperative imaging cohort. No difference regarding adjuvant therapies could be found. CONCLUSIONS Timing of imaging affects the detection rate of unspecific lymph node enlargements but does not show a significant effect on the rate of adjuvant therapies.
Collapse
Affiliation(s)
- Robert Dotzauer
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany -
| | - Arash Salamat
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Nikita D Nabar
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Anita Thomas
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Böhm
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - René Mager
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Martin Kurosch
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Hoefner
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Andreas M Hötker
- Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Rämigstrasse, Switzerland
| | - Axel Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| |
Collapse
|
15
|
Nwosu OI, Jones AJ, Alwani M, Einhorn LH, Moore MG, Mantravadi AV. Surgical Management of Cervical Non-seminomatous Germ Cell Tumor Metastases. Laryngoscope 2021; 131:1528-1534. [PMID: 33421136 DOI: 10.1002/lary.29364] [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: 11/17/2020] [Accepted: 12/18/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE/HYPOTHESIS Testicular cancer is the most common malignancy of young males. Limited reports describe perioperative and long-term outcomes after surgical resection of metastatic, cervical, non-seminomatous germ cell tumors (NSGCT). The objective of this study was to investigate the effectiveness and safety of cervical lymphadenectomy in the management of metastatic NSGCT. STUDY DESIGN Retrospective case series. METHODS A single institution, retrospective review from 1998 to 2020 of patients with metastatic NSGCT who underwent cervical lymphadenectomy was conducted. Clinicopathological, surgical, and postoperative data were collected and analyzed. RESULTS Sixty-eight predominantly white (91.0%) male patients with mean age 33.0 ± 11.3 years were included. Most (82.2%) presented with stage III disease at initial diagnosis. All patients had undergone primary platinum-based chemotherapy 1.0 to 22.7 months prior to selective ND. Surgery mainly involved nodal levels III (67.6%), IV (92.6%) and/or Vb (77.9%) and was frequently performed with concomitant thoracoabdominal NSGCT resections (63.2%). Cervical specimens predominantly revealed mature teratoma (83.8%) as solitary (69.1%) or component of mixed (14.7%) NSGCT. Ten (14.7%) perioperative complications occurred as vocal cord paresis (n = 6) from thoracic surgery and chyle leakage (n = 4). All resolved conservatively except two vocal cord paralyzes that required surgical repair due to tumor involvement of vagus nerve. Six instances of cervical recurrence occurred at median 12.5 (range, 5.8-38.6) months from ND, all re-demonstrating purely mature teratoma. The two-year cervical, non-cervical, and overall recurrence-free survivals were 83%, 55%, and 55%, respectively. Two-year disease-free and overall survivals were both 93%. CONCLUSIONS Selective neck dissection is a safe, effective method for managing cervical NSGCT metastases. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1528-1534, 2021.
Collapse
Affiliation(s)
- Obi I Nwosu
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Alexander J Jones
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Mohamedkazim Alwani
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Lawrence H Einhorn
- Department of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Michael G Moore
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Avinash V Mantravadi
- Department of Otolaryngology Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| |
Collapse
|
16
|
|
17
|
Abstract
Testicular cancer is responsible for approximately 0.1% of all cancer deaths in the USA, and seminoma is the most common type of testicular tumor. Ultrasonography is the primary imaging modality for accessing testicular and extratesticular lesions, while magnetic resonance imaging can be used for problem solving in lesion characterization in certain cases. CT imaging is usually performed for retroperitoneal staging of testicular cancer metastasis and follow-up after treatment. Extratesticular masses are common, yet rarely malignant. Imaging plays an important role in primary diagnosis of testicular cancer and differentiating it from common non-neoplastic findings. The purpose of this article is to review various imaging findings in testicular and extratesticular masses.
Collapse
|
18
|
O'Shea A, Kilcoyne A, Hedgire SS, Harisinghani MG. Pelvic lymph nodes and pathways of disease spread in male pelvic malignancies. Abdom Radiol (NY) 2020; 45:2198-2212. [PMID: 31673716 DOI: 10.1007/s00261-019-02285-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Accurate nodal staging for male urogenital malignancies has important implications for therapy and prognosis. Male pelvic malignancies, including prostatic, penile, testicular, and bladder cancer, typically metastasize to regional lymph nodes first which is reported by the N-stage. Spread beyond these groups to non-regional nodes is regarded as M-stage disease. METHODS In this review, we discuss the typical patterns of male pelvic lymphatic drainage and the tumor-specific regional nodal chains. RESULTS The impact of tumor-specific imaging features and the implications of previous treatments on staging are discussed. CONCLUSIONS While anatomic imaging, including CT and MRI, is the most widely employed imaging modality at present, newer functional imaging techniques have demonstrated promise in the accurate identification and characterization of nodal metastases.
Collapse
Affiliation(s)
- Aileen O'Shea
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Aoife Kilcoyne
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
19
|
Kumar N, Singh UP, Lal H, Sureka SK. Testicular seminoma with large direct iliac nodal metastasis: unusual presentation. BMJ Case Rep 2020; 13:13/6/e236702. [PMID: 32606108 DOI: 10.1136/bcr-2020-236702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Naveen Kumar
- Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Uday Pratap Singh
- Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Hira Lal
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjoy Kumar Sureka
- Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
20
|
Thomas KL, Jeong D, Montilla-Soler J, Feuerlein S. The role of diagnostic imaging in the primary testicular cancer: initial staging, response assessment and surveillance. Transl Androl Urol 2020; 9:S3-S13. [PMID: 32055480 DOI: 10.21037/tau.2019.07.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Testicular cancers are a group of uncommon malignancies that account for less than 1% of new cancer cases per year in the United States and globally. The disease typically affects men between the ages of 20-44, and the overwhelming majority of tumors are germ cell in origin. Most cases of testicular cancer are organ confined at diagnosis and have a good overall prognosis. Testicular cancers are staged by the tumor, node, metastasis, serum markers (TNMS) classification set forth by the American Joint Commission on Cancer staging. Diagnostic imaging plays a crucial role in initial staging, specifically in assessing the primary tumor prior to orchiectomy and evaluating for regional and/or distant metastasis. Multimodality imaging is used for initial staging, with ultrasound and computed tomography (CT) most commonly utilized. Diagnostic imaging is also important in evaluating response in patients who initially present with metastatic disease as well as in patients who are undergoing surveillance. Typically, CT is used for response assessment and surveillance, with magnetic resonance imaging (MRI) and positron emission tomography (PET) serving as adjunct modalities. This article reviews the role of various diagnostic imaging modalities and how they are employed in the diagnosis, staging, response assessment and surveillance of primary testicular cancer.
Collapse
Affiliation(s)
- Kerry L Thomas
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jaime Montilla-Soler
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sebastian Feuerlein
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| |
Collapse
|
21
|
Werntz RP, Eggener SE. Defining risk of micrometastatic disease and tumor recurrence in patients with stage I testicular germ cell tumors. Transl Androl Urol 2020; 9:S31-S35. [PMID: 32055483 DOI: 10.21037/tau.2019.06.20] [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] [Indexed: 12/13/2022] Open
Abstract
There is controversy in the management of patients with clinical stage I non-seminomatous germ cell tumor (NSGCT). Some experts recommend surveillance for all patients regardless of risk factors while others suggest a more risk-adapted approach by using lymphovascular invasion (LVI) and the embryonal component in the primary tumor to select patients most likely to benefit from primary treatment [retroperitoneal lymph node dissection (RPLND) or chemotherapy]. With the surveillance for all strategy, only patients who relapse are treated. While this minimizes the over treatment, problem associated with the risk adapted approach, this exposes young men to the effects of full induction cisplatin-based chemotherapy when these men could have received fewer cycles of bleomycin, etoposide, and cisplatin (BEP) or a curative primary RPLND. The challenge is identifying these men who are most likely to benefit from upfront treatment more precisely. This paper explores the currently risk adapted approaches as well as promising emerging biomarkers (microRNA) that, in early data, appear to more accurately predict the presence of microscopic disease in the retroperitoneum over conventional markers.
Collapse
Affiliation(s)
- Ryan P Werntz
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
22
|
|