Follow‐up of clinical stage I testicular cancer patients: Cost and risk benefit considerations

Abstract

Background: Regardless of the way it is managed, a high cure rate has been achieved for recurrent low-stage testicular cancer. Achieving a balance between survival and the patient's inconvenience and expense during follow-up, has therefore become an important issue. Methods: Prognoses and recurrence patterns were investigated in 39 patients with stage I nonseminomatous germ cell tumor of the testis (NSGCT), and 82 patients with stage I seminomatous germ cell tumor of the testis (SGCT), who underwent high orchiectomy between 1970 and 1997 at our institution. We considered the cost benefits and the risks by reviewing our results together with other reported results.Results: Patients with clinical stage I NSGCT under surveillance showed no progression later than 4 years after orchiectomy. The ability to detect progression using chest X-ray alone appeared very low. There was no infradiaphragmatic recurrence after adjuvant radiotherapy for patients with stage I SGCT. Only two of 204 patients showed progression, which included eight of our patients who underwent two cycles of adjuvant carboplatin therapy. Conclusions: Four years of intensive follow-up is probably sufficient for patients with stage I NSGCT under surveillance, and routine chest X-rays may be required only during the first year of surveillance. The benefit of using adjuvant radiotherapy for patients with stage I SGCT is that we could remove abdominal and pelvic CT scans from the routine follow-up protocol. Randomized trials will clarify whether the adjuvant carboplatin therapy is less toxic, provides better prognosis and is more cost-effective than adjuvant radiotherapy.

Posttreatment surveillance after paraaortic radiotherapy for stage I seminoma: a systematic analysis

“…This change in relapse pattern has also been discussed by Taylor et al (2001) suggesting that pelvic imaging should particularly be considered when relapse from seminoma was suspected. In contrast to other series of PA or dog-leg radiotherapy for stage I seminoma (Logue et al 2003;Kakehi et al 2002), we also observed Weld edge recurrences without involvement of pelvic nodes in ten patients. Furthermore, approximately 20% of all relapses included retroperitoneal lymph nodes.…”

“…Even though the optimal schedule of follow-up remains to be deWned, posttreatment surveillance is routinely recommended with the aim to detect relapse from seminoma as well as contralateral second cancers (Krege et al 2008b;Albers et al 2005;Souchon et al 2002). A number of publications have depicted on the topic of follow-up in testis cancer in general (Souchon et al 2002;Spermon et al 2004) or with a more speciWc focus like cost-eVectiveness (Buchholz et al 1998;Sharda et al 1996;Kakehi et al 2002), the role of tumor markers (Trigo et al 2000), or the use of chest imaging (Harvey et al 2002). To our knowledge, there have only been three previous publications on the speciWc requirements for posttreatment surveillance after paraaortic radiotherapy in stage I seminoma based on two large patient cohorts (Claßen et al 2005;Livsey et al 2001;Taylor et al 2001).…”

Economy of Standards: European Association of Urology Guideline Changes Influence Treatment Costs in Stage I Testicular Cancer Patients

“…Contrary to our own results, Sokoloff et al [20] found a 10% increase in total costs between 1994 and 2000, mainly driven by higher expenditures for outpatient visits and ambulatory surgery. This might reflect the close follow-up of patients on AS when this concept was new at the end of the nineties [18]. …”

“…In 2001, Kakehi et al [18] calculated costs for an AS regime for the first year after orchiectomy for a cohort of 121 patients with CS I TC treated at their institution in Japan between 1970 and 1997. Expenditures were estimated at about EUR 1.910, which is noticeably above our own calculation, which showed costs of about EUR 430 for the same period.…”

Management of Non-Seminomatous Germ Cell Tumor of the Testis

“…There is concern that non-compliance may translate into a decrease in disease specific survival. (Colls et al, 1999;Gels et al, 1995;Kakehi, Kamoto, Kawakita, & Ogawa, 2002;Raghavan et al, 1988) Nevertheless, the true impact of non-compliance on survival is unknown. A national surveillance study in New Zealand failed to correlate non-compliance with compromise in cure.…”