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Da Silva A, Fléchon A, Coquan E, Planchamp F, Culine S, Murez T, Méjean A, Pasquier D, Chevreau C, Fizazi K, Thiery-Vuilemin A, Joly F. How to improve adherence of guidelines for localized testicular cancer surveillance: A Delphi consensus study. Front Oncol 2022; 12:1036190. [PMID: 36324582 PMCID: PMC9619048 DOI: 10.3389/fonc.2022.1036190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
Stage-I testicular germ-cell tumor (TGCT) has excellent cure rates. Surveillance is fully included in patient's management, particularly during the first years of follow-up. Surveillance guidelines differ between the academic societies, mainly concerning imaging frequency and long-term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. First, an online survey on surveillance practice of stage-I TGCT based on clinical-cases was conducted among urologists, radiation-oncologists and medical-oncologists. These results were compared to ESMO/EAU and AFU guidelines. Then a panel of experts assessed surveillance proposals following a Delphi-CM. Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. The study was conducted between July 2018 and May 2019. Concerning the first step: 61 participated to the survey (69% medical-oncologists, 15% urologists, 16% radiation-oncologists). About 65% of practitioners followed clinico-biological guidelines concerning 1 to 5 years of follow-up, but only 25% stopped surveillance after the 5th-year. No physician followed the EAU/ESMO guidelines of de-escalation chest imaging. Concerning the second step: 32 experts (78% medical-oncologists, 16% urologists, 6% radiation-oncologists) participated to the Delphi-CM. Thanks to Delphi-CM, a consensus was reached for 26 of the 38 statements. Experts agreed on clinico-biological surveillance modalities and end of surveillance after the 5th-year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th-year of follow-up. No consensus was reached regarding de-escalation of chest imaging. To conclude, the survey proved that French TGCT-specialists do not follow current guidelines. With Delphi-CM, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th-year, stop of AP scan on the 4th-year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.
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Affiliation(s)
| | - Aude Fléchon
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | - Elodie Coquan
- Centre François-Baclesse, Department of Medical Oncology, Caen, France
- Centre François-Baclesse, Clinical Research Unit, Caen, France
| | | | - Stéphane Culine
- Hôpital Saint-Louis, Department of Medical Oncology, Paris, France
| | - Thibaut Murez
- Hôpital Lapeyronie, Department of Urology, Montpellier, France
| | - Arnaud Méjean
- Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Department of Urology, Paris, France
| | - David Pasquier
- Centre Oscar Lambret, Department of Radiation Oncology, Lille, France
| | | | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Department of Medical Oncology, Villejuif, France
| | | | - Florence Joly
- Centre François-Baclesse, Department of Medical Oncology, Caen, France
- Centre François-Baclesse, Clinical Research Unit, Caen, France
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