Canadian consensus guidelines for the management of testicular germ cell cancer

Wood, Lori; Kollmannsberger, Christian; Jewett, Michael A.S.; Chung, Peter; Hotte, S. J.; O’Malley, Martin; Sweet, Joan; Anson‐Cartwright, Lynn; Winquist, Eric; North, Scott; Tyldesley, Scott; Sturgeon, J.; Gospodarowicz, Mary K.; Segal, Roanne; Cheng, Tina; Venner, Peter; Moore, Malcolm J.; Albers, Peter; Huddart, Robert; Nichols, Craig R.; Warde, Padraig

doi:10.5489/cuaj.815

Cited by 123 publications

(84 citation statements)

References 200 publications

(204 reference statements)

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“…As standard treatment for first-line poor prognosis patients is four cycles of CDCT, it seems logical that the same might be true in patients receiving first salvage who are at even higher risk. 16 This might also in part explain the negative results of the IT-94 first salvage trial, where four cycles of VIP were compared to three cycles plus HDCT. 5 In addition to the toxicity of the HDCT regimen, the potential benefits of HDCT might have been abrogated by inferior CDCT exposure in the experimental arm; superior survival in the subgroup of patients receiving HDCT who were in remission after three cycles of CDCT supports this result.…”

Section: Discussionmentioning

confidence: 99%

Consolidative high-dose chemotherapy after conventional-dose chemotherapy as first salvage treatment for male patients with metastatic germ cell tumours

Beausoleil

Ernst

Stitt

et al. 2012

CUAJ

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Introduction: Some men with metastatic germ cell tumours that have progressed after response to initial cisplatin-based combination chemotherapy are cured with conventional dose first salvage chemotherapy (CDCT) -however, many are not. High-dose chemotherapy with autologous stem cell rescue (HDCT) may be of value in these patients. Prognosis has recently been better defined by International Prognostic Factor Study Group (IPFSG) prognostic factors. HDCT after response to CDCT has been offered at our institution over the past two decades. We retrospectively assessed the validity of the IPFSG prognostic factors in our patients and evaluated the value of HDCT. Methods: We identified eligible men with metastatic germ cell tumour progressed after at least 3 cycles of cisplatin-based chemotherapy and treated with cisplatin-based CDCT alone or with carboplatin-based HDCT. We also collected their clinical data. Patients were classified into risk groups using IPFSG factors, and progression-free and overall survival factors were analyzed and compared in patients treated with CDCT alone and with HDCT. Results: We identified 38 eligible first salvage patients who had received a median of 4 cycles (range, 1 to 7 cycles) of CDCT. Twenty patients received CDCT alone and 18 patients received CDCT plus HDCT. The overall median progression-free survival was 24.6 months (95%CI, 7.3 to 28.7 months) and overall median overall survival was 34.6 months (95%CI, 17.2 to 51.3 months). Distribution by IPFSG category and 2-year progression-free survival and 3-year overall survival rates within each risk category were very similar to the IPFSG results. There were two toxic deaths with CDCT and none with HDCT. Overall, patients treated with CDCT plus HDCT had improved progression-free survival and overall survival. Conclusions: The IPFSG prognostic risk factors appeared valid in our patient population. The safety of HDCT with etoposide and carboplatin was confirmed. HDCT was associated with improved progression-free survival and overall survival outcomes, consistent with observations of the IPFSG group. Ideally, the value of optimal HDCT should be determined in comparison to optimal CDCT as first salvage therapy in men with metastatic germ cell tumour with a randomized trial.

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Section: Discussionmentioning

confidence: 99%

Consolidative high-dose chemotherapy after conventional-dose chemotherapy as first salvage treatment for male patients with metastatic germ cell tumours

Beausoleil

Ernst

Stitt

et al. 2012

CUAJ

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“…Die konsequente Anwendung der Standardtherapien sowie deren gute Wirksamkeit hat auch noch innerhalb der letzten 15 Jahre zu einer deutlichen Senkung der Rezidivrate nach erfolgter kurativer Therapie geführt [3]. In den letzten Jahren hat sich zudem für die Behandlung des Früh-stadiums des seminomatösen als auch des nichtseminomatösen Hodenkarzinoms die aktive Nachsorge ("active surveillance") als Therapieoption fest etabliert [4]. In dieser Situation ist die korrekte Nachsorge dieser Patienten von vitaler Bedeutung.…”

Section: Originalien Hintergrund Und Fragestellungunclassified

Nachsorge von Patienten mit Hodentumoren

Hartmann

Krege²,

Souchon

et al. 2011

Urologe

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Recently, new evidence has become available regarding the relapse pattern of different disease stages of testicular cancer, the use of imaging at follow-up, and the risks of excessive radiation due to imaging, in particular that of CT scans. An interdisciplinary multinational working group consisting of urologists, medical oncologists, and radiation oncologists has reviewed and discussed the current evidence and on this basis formulated new recommendations for patients with germ cell tumors of the testis.

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“…The reported risk of relapse after adjuvant therapy for stage 1 seminoma is less than 5%, 20,46 and thus followup intensity may be less than surveillance. In the MRC combined analysis of the TE10, TE18 and TE19 trials for stage I seminoma, the risk of recurrence more than 3 years after adjuvant therapy with either radiotherapy or carboplatin chemotherapy was very low, with only 4 cases of recurrence (0.2%) beyond 3 years.…”

Section: Adjuvant Therapymentioning

confidence: 99%

Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach

Lieng

Warde

Bedard

et al. 2017

CUAJ

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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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Canadian consensus guidelines for the management of testicular germ cell cancer

Cited by 123 publications

References 200 publications

Consolidative high-dose chemotherapy after conventional-dose chemotherapy as first salvage treatment for male patients with metastatic germ cell tumours

Consolidative high-dose chemotherapy after conventional-dose chemotherapy as first salvage treatment for male patients with metastatic germ cell tumours

Nachsorge von Patienten mit Hodentumoren

Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach

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