Controversies in the Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

Ondruš, D; Kajo, Karol; Stastna, V.; Ondrušová, Martina

doi:10.14735/amko2015112

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…The question whether two cycles of carboplatin result in lower relapse rates compared to the one course regimen has not been systematically evaluated. However, three studies indicated relapse rates of > 10% ensuing from the one course regimen [ 37 , 40 , 41 ], while all single-arm studies employing the two-course regimen reported relapse rates < 5%. On the other hand, a worse outcome was observed in cases relapsing after two cycles of carboplatin, although some selection bias must be considered in that retrospective study [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Testicular germ cell tumours’ clinical stage I: comparison of surveillance with adjuvant treatment strategies regarding recurrence rates and overall survival—a systematic review

et al. 2022

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Purpose Testicular germ cell tumours (GCTs) represent the most common malignancy in young adult males with two thirds of all cases presenting with clinical stage I (CSI). Active surveillance is the management modality mostly favoured by current guidelines. This systematic review assesses the treatment results in CSI patients concerning recurrence rate and overall survival in non-seminoma (NS) and pure seminoma (SE) resulting from surveillance in comparison to adjuvant strategies. Methods/systematic review We performed a systematic literature review confining the search to most recent studies published 2010-2021 that reported direct comparisons of surveillance to adjuvant management. We searched Medline and the Cochrane Library with additional hand-searching of reference lists to identify relevant studies. Data extraction and quality assessment of included studies were performed with stratification for histology (NS vs. SE) and treatment modalities. The results were tabulated and evaluated with descriptive statistical methods. Results Thirty-four studies met the inclusion criteria. In NS patients relapse rates were 12 to 37%, 0 to 10%, and 0 to 11.8% for surveillance, chemotherapy and for retroperitoneal lymph node dissection (RPLND) while overall survival rates were 90.7−100%, 91.7−100%, and 97−99.1%, respectively. In SE CSI, relapse rates were 0−22.3%, 0−5%, and 0−12.5% for surveillance, radiotherapy, chemotherapy, while overall survival rates were 84.1−98.7%, 83.5−100%, and 92.3−100%, respectively. Conclusion In both histologic subgroups, active surveillance offers almost identical overall survival as adjuvant management strategies, however, at the expense of higher relapse rates. Each of the management strategies in CSI GCT patients have specific merits and shared-decision-making is advised to tailor treatment.

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