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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Dotzauer R, Salamat A, Nabar ND, Thomas A, Böhm K, Brandt MP, Mager R, Borgmann H, Kurosch M, Hoefner T, Tsaur I, Hötker A, Haferkamp A, Jäger W. The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making. Minerva Urol Nefrol 2021. [PMID: 33439568 DOI: 10.23736/s0393-2249.20.03877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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.
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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 Hötker
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, 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
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Nabar ND, Brandt MP, Thomas C, Tsaur I, Bartsch G, Jaeger W, Haferkamp A, Höfner T. Immune check point inhibitors for metastatic urothelial carcinoma: current evidence-based approach for urology daily practice. MINERVA UROL NEFROL 2018; 71:205-216. [PMID: 30021426 DOI: 10.23736/s0393-2249.18.03117-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Treatment strategy for inoperable and metastatic urothelial carcinoma (mUC) has been revolutionized by the introduction of programmed cell death protein 1 (PD-1) and programmed cell death protein ligand (PD-L1) antibodies. During the last 3 decades treatment options were limited to chemotherapy, making further treatment of patients whose disease progressed under ongoing therapy or who were ineligible to receive cytotoxic therapy in the first place, nearly impossible. EVIDENCE ACQUISITION Five antibodies including pembrolizumab (PD-L1 antibody), atezolizumab (PD-1 antibody), nivolumab (PD-1 antibody), avelumab and durvalumab (PD-L1 antibodies) have been approved in the treatment of advanced urothelial carcinoma in first- and second-line treatment setting. The objective of this review was to examine and compare the different cohorts and to discuss the quality of the respective studies in order to set up selection criteria for clinical decision making. EVIDENCE SYNTHESIS So far pembrolizumab and atezolizumab have demonstrated overall survival (OS) benefit in phase II studies and have shown superiority over standard chemotherapy in phase III studies which has granted them approval in first and second-line treatment setting. Improved OS and durable responses were also seen in phase Ib/II non-randomized, single-arm trials conducted with nivolumab, avelumab and durvalumab and granting accelerated approval for second-line treatment. The huge advantage of immunotherapy and one of the reasons for its overall recognition is its good tolerability profile especially in comparison to chemotherapy. CONCLUSIONS Pembrolizumab has to be recommended in second-line therapy due to reporting in a phase III trial and OS survival benefit compared to chemotherapy control group. In cisplatin-eligible and treatment-naïve patients with visceral or liver metastases data also slightly favors pembrolizumab rather than atezolizumab.
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Affiliation(s)
- Nikita D Nabar
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany -
| | - Maximilian P Brandt
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
| | - Christian Thomas
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
| | - Georg Bartsch
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
| | - Wolfgang Jaeger
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
| | - Thomas Höfner
- Department of Urology and Pediatric Urology, University Hospital of Mainz, Mainz, Germany
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