Oncological Outcomes of Metastatic Testicular Cancers under Centralized Management through Regional Medical Network

Abstract

Objective: To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network. Materials and methods: We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin. Results: Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate-and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was .0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate-and poor-prognosis groups were 97, 93 and 84%, respectively. Conclusions: Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.

Advanced germ cell tumor patients undergoing post‐chemotherapy retroperitoneal lymph node dissection: Impact of residual teratoma on prognosis

“…1). At TUH, first‐line chemotherapy involves three to four courses of BEP, according to the IGCCCG risk criteria 3 . To avoid bleomycin‐induced pulmonary toxicity, an EP regimen or a VIP regimen was used instead of a BEP regimen for patients with risk factors for bleomycin, such as those aged >50 years 3 .…”

“…At TUH, first‐line chemotherapy involves three to four courses of BEP, according to the IGCCCG risk criteria 3 . To avoid bleomycin‐induced pulmonary toxicity, an EP regimen or a VIP regimen was used instead of a BEP regimen for patients with risk factors for bleomycin, such as those aged >50 years 3 . For patients with aggressive lung metastases or those at high risk of other pulmonary complications, EP or VIP was used during the first or second course of treatment.…”

“…PC‐RPLND is a complex surgical procedure, therefore, most guidelines recommend referral to high‐volume centers 1,2 . As centralized management is preferred not only for RPLND but also for chemotherapy in advanced cases, we have introduced risk‐adapted management for patients with advanced GCT through a regional network involving TUH and branch hospitals in the Ibaraki Prefecture 3 …”

“…Through this network, community hospitals refer all patients with advanced disease, poor‐risk disease, or risk factors for chemotherapy to TUH 3 . Additionally, implementation of second‐line or subsequent chemotherapy is principally centralized to TUH.…”

Interdisciplinary Management of Testicular Germ Cell Tumors - More Needed than Ever!

“…These data also raise the question to centralizing the care of TGCT patients to dedicated and experienced referral centers as it already has been performed in some European and non-European countries [3,4]. …”