Combination carboplatin and radiotherapy in the management of stage II testicular seminoma: comparison with radiotherapy treatment alone

Patterson, Helen; Norman, A.; Mitra, Swarupa; Nicholls, J.; Fisher, Cyril; Dearnaley, David P.; Horwich, A.; Mason, Malcolm David; Huddart, Robert

doi:10.1016/s0167-8140(00)00240-1

Cited by 94 publications

(37 citation statements)

References 16 publications

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“…There is considerable variability on how stage IIa/b seminomas are treated. The treatment options for stage IIa/b seminomas include, para-aortic and iliac node radiotherapy (Schmidberger et al, 1997;Warde et al, 1998;Classen et al, 2003;Chung et al, 2004), three cycles of BEP (bleomycin, etoposide and cisplatin) or four cycles of EP (etoposide and cisplatin) chemotherapy or a combination of carboplatin chemotherapy and para-aortic radiotherapy (Warde et al, 1998;Arranz Arija et al, 2001;Patterson et al, 2001). All three of the above options provide high rates of cure, but with differing toxicity profiles.…”

Section: Stages Iia/bmentioning

confidence: 99%

“…We know that radiotherapy is highly effective in eradicating disease with up to 5 cm in size in the para-aortic nodes (Classen et al, 2003;Chung et al, 2004). Our current protocol for treating patients with stage IIa/b disease, is to give one cycle of carboplatin (AUC 7) followed 4 weeks later by para-aortic radiotherapy to a dose of 30 Gy in 15 fractions based on 5-year relapse-free survival probability of 96.9% (Patterson et al, 2001) achieved at our institution. We suggest 3-monthly clinic examinations and markers for the first year, 4 monthly for the second year, 6 monthly until year 5 and then annual review.…”

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confidence: 99%

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Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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Testicular germ cell tumours (TGCTs) are the most common cause of cancer in men between the ages of 15 and 40 years, and, overall, the majority of patients should expect to be cured. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma and nonseminomatous germ cell tumours. There is, however, no international consensus on how best to follow patients after their initial management. This must promptly and reliably identify relapses without causing further harm. The standardising of follow-up would result in optimising risk-benefit ratios for individual patients, while ensuring economic use of resources. We have identified the seven common scenarios in managing seminomas and nonseminomas of the various stages and discuss the pertinent issues around relapse and follow-up. We review the available literature and present our comprehensive TGCT follow-up guidelines. Our protocols provide a pragmatic, easily accessible user-friendly basis for other centres to use or to adapt to suit their needs. Furthermore, this should enable future trials to address specific issues around follow-up giving meaningful and useful results. BackgroundTesticular germ cell tumours (TGCTs) are uncommon malignancies but the most common cause of cancer in men between the ages of 15 and 40 years. The peak incidence for nonseminomatous germ cell tumour (NSGCT) is between 20 and 30 years of age, and for seminoma between 30 and 40 years. In the United Kingdom, the incidence rate is only 1 : 100 000 men per year with a lifetime risk of developing a TGCT of 1 in 400 and 1900 new cases per year (Horwich, 2002). There has, however, been a steady increase in the incidence of TGCTs in European countries in the last two decades (Bergstrom et al, 1996). The reasons for this increasing incidence and the aetiology of TGCTs remain unknown. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma tumour and NSGCT (Schmoll et al, 2004). There is, however, a lack of clear consensus on how to follow patients after primary treatment, and a number of issues dictate that follow-up should be carefully thought out and rigorously adhered to. Here, we discuss these factors as they pertain to male germ cell tumour (GCT) practice and describe our recently developed protocols. Rational for follow-upDetecting relapse In general, detecting relapse is the major reason for maintaining follow-up and is the main focus of this review. The management of testicular cancer has been a major oncological success story, and provides a model for the management of curative solid tumours (Horwich et al, 2006). The use of platinumbased chemotherapy schedules has resulted in high cure rates for all stages of the disease (International Germ Cell Cancer Collaborative Group, 1997). The fact that the majority of young men treated for testicular cancer have a durable response to primary treatment has resulted in the accumulation of significant data on both the patterns ...

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Section: Stages Iia/bmentioning

confidence: 99%

mentioning

confidence: 99%

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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“…Other small series of patients receiving definitive radiotherapy for stage II seminoma have reported similar patterns of relapse to supradiaphragmatic sites, with in-field relapses rare. [64][65][66] Our report of 49 men with stage IIA seminoma treated with radiotherapy to the paraaortic nodes and pelvis found none of the 4 relapses were in the radiation volume; of the 30 men with stage IIB seminoma who received abdominopelvic radiotherapy, 3 experienced disease relapse including 2 cases of relapse to the left supraclavicular nodes +/ left axilla, and 1 case of paraaortic relapse. 3 The commonest time to relapse was in the first two years after treatment, with all relapses occurring by 4 years.…”

Section: Cuaj -Review Lieng Et Al Followup Of Stage I and Ii Seminomamentioning

confidence: 78%

“…3,4,64 Upon completion of radiotherapy, we perform a CT abdomen and pelvis at 3 months, then every 3-6 months until a complete radiological response with normalization of imaging is observed. Because of the reported high rates of infield disease control and pattern of relapse to supradiaphragmatic sites, 3,4,8,65,66 we do not routinely perform further abdominal imaging after radiological response is documented. Based on patterns of failure, our followup protocol includes chest imaging, and given the high doses of radiation associated with chest CTs, we recommend CXRs at 6-monthly intervals for the first 3 years, then annually until year 5, with biennial imaging until year 9 ( Table 2).…”

Section: Definitive Radiotherapymentioning

confidence: 99%

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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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Late recurrence in 1263 men with testicular germ cell tumors

Shahidi

Norman

Dearnaley

et al. 2002

Cancer

119

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Combination carboplatin and radiotherapy in the management of stage II testicular seminoma: comparison with radiotherapy treatment alone

Cited by 94 publications

References 16 publications

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

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

Late recurrence in 1263 men with testicular germ cell tumors

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