Low-Dose Computed Tomography Surveillance of Patients with Testicular Tumours

Fitzgerald, Richard; Twiss, D; Mehra, Rajesh; Evans, Mrb; Qaiyum, M; Collins, Michael

doi:10.1016/j.clon.2003.11.004

Cited by 13 publications

(4 citation statements)

References 9 publications

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“…A conventional computed tomography scan of the abdomen and pelvis gives a radiation exposure of 6 mSv to 14 mSv, and patients are, therefore, exposed to a significant amount of radiation from computed tomography imaging over the course of follow-up after carboplatin or on surveillance. 31,32 Whereas, to date, there has been no direct study that shows harmful effects from the x-ray exposure associated with computed tomography scanning, concern about secondary malignancies has been raised in literature. 32,33 In 1 study, the risk of cancer death from a single computed tomography scan of the abdomen was estimated to be 12.5 in 10,000.…”

Section: Discussionmentioning

confidence: 99%

Evidence‐based guidelines for following stage 1 seminoma

Martin

Panzarella

Zwahlen

et al. 2007

Cancer

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A chemically crosslinked biodegradable hydrogel was prepared via a macromer technique, and physicochemical characterizations associated with its potential application as an injectable biomaterial were carried out. The macromers were composed of poly(ethylene glycol) extended with oligomers of biodegradable polyesters such as oligolactide and end‐capped with acryloyl groups. Hydrogels were obtained through the polymerization of the macromer aqueous solutions in phosphate‐buffered saline initiated by a redox initiator system at body temperature. The initiator system was composed of ammonium persulfate as an initiator and N,N,N′,N′‐tetramethylethylene diamine as an accelerator. The modulus of this chemical gel was much higher than that of a Pluronic physical gel. In vitro biodegradation was also confirmed. The degradation rates were highly tunable by the adjustment of several factors, such as the kind of ester group, the block length of the oligoester, and even the concentration of the accelerator used in the crosslinking reaction. The gelation time could be adjusted to meet the requirements of an injectable biomaterial. The effect of the polymerization heat seemed not to be significant. This kind of biodegradable hydrogel might be in situ formed after being injected into the body and shows potential applications as a unique tissue engineering material free of porogening techniques in scaffold fabrication and less invasive in implantation. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci, 2006

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Section: Discussionmentioning

confidence: 99%

Evidence‐based guidelines for following stage 1 seminoma

Martin

Panzarella

Zwahlen

et al. 2007

Cancer

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“…This approach should be investigated in stage I seminoma. An alternative is to use low-dose diagnostic CT imaging which can reduce the radiation dose by 60-70%, and this is been investigated in a phase II setting at PMH [7].…”

Section: Follow-up Policymentioning

confidence: 99%

Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma

2006

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Treatment options in patients with stage I seminoma include radiotherapy (RT), surveillance, and adjuvant chemotherapy. This patient population has virtually a 100% cure rate whichever approach is taken. While adjuvant retroperitoneal RT has been the standard of care for the past 50-60 years, there is increasingly persuasive data that adjuvant RT in this setting is associated with a small but definite increased risk of second malignancy and cardiovascular death. The long-term data from surveillance series have documented the safety of this approach, and it is now accepted that a policy of surveillance is the optimal management approach. This gives a relapse rate of 15%, and most patients can be successfully salvaged with RT. Second relapse after salvage RT occurs in a small proportion of cases, and these patients are cured with chemotherapy. Adjuvant chemotherapy using carboplatin has been investigated as an alternative strategy but has not lived up to its initial promise. If used, then 2 courses of treatment should probably be given. It must be remembered that 80-85% of patients with testicular seminoma require no treatment after orchiectomy, and the long-term side effects of any adjuvant treatment approach must be carefully considered.

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“…Concerns have been raised about the high radiation exposure that patients are subjected to whilst being followed on the surveillance protocol with serial CT. As mentioned above, patients on surveillance will have 6–20 scans of the abdomen and pelvis over a period of up to 10 years. Conventional CT of the abdomen and pelvis gives a radiation exposure of 6–14 mSv and patients are therefore exposed to a significant amount of radiation from CT imaging over the course of a surveillance protocol [38,39]. Concern about secondary malignancies from the X‐ray exposure associated with CT has been raised [39,40].…”

Section: Management Of Survivorsmentioning

confidence: 99%

“…This study also addresses follow‐up frequency, comparing three visits to seven visits over a 5‐year period. An alternative approach is to use low‐dose CT; this considerably reduces (from 6.3 to 1.6 mSv in one protocol for CT of the abdomen) the radiation exposure associated with conventional CT in patients with testicular GCTs, at the expense of slightly degraded image quality [38,41].…”

Section: Management Of Survivorsmentioning

confidence: 99%