One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group

Tandstad, Torgrim; Ståhl, Olof; Håkansson, Ulf; Dahl, Olav; Haugnes, Hege Sagstuen; Klepp, Olbjørn; Langberg, Carl W.; Laurell, Anna; Oldenburg, Jan; Solberg, Arne; Söderstrom, Karin; Cavallin‐Ståhl, Eva; Stierner, Ulrika; Wahlquist, Rolf; Wall, Najme; Cohn‐Cedermark, Gabriella

doi:10.1093/annonc/mdu375

Cited by 125 publications

(79 citation statements)

References 26 publications

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“…The updated and expanded results from SWENOTECA group confirm a low relapse rate following one course of adjuvant BEP in CS1 non-seminoma [40]. At a median follow-up of 7.9 years, 12 relapses had occurred, all with the International Germ Cell Cancer Collaborative Group (IGCCCG) good prognosis.…”

Section: Bep (One Vs Two Cycles)mentioning

confidence: 84%

“…Risk-adapted treatment is based on the risk factor, vascular invasion. Stratifying patients with CS1 NSGCT according to their presumed risk of relapse is a rational option, as several studies have reported similar survival rates and a final cure rate close to 100% with all available treatment options using the risk-stratifying approach [28,[33][34][35][36][37][38][39][40][41][42][43].…”

Section: Active Surveillancementioning

confidence: 99%

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Current Concepts in Management of Stage I NSGCT

Ahluwalia

Gautam

2016

Indian J Surg Oncol

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While about 50% of non-seminomatous germ cell tumors of the testes present as clinical stage I (CSI), further management of these patients continues to be mired in controversy. Active surveillance is a frontline option for low-risk CS I patients and according to some, even the high-risk ones with high embryonal carcinoma (ECA) component and vascular invasion (VI). However, it carries the disadvantage of long-term surveillance, the need for prolonged chemotherapy in case of recurrence and the possibility of secondary malignancies due to radiation exposure from frequent CT scans. One or two cycles of BEP chemotherapy is a popular alternative to active surveillance which carries a very low relapse rate, but valid concerns about overtreatment of a majority of patients, with the attendant chemotherapy-related toxicity exist. Retroperitoneal lymph node dissection has been used as a means of avoiding chemotherapy, especially in high-risk patients, but carries the disadvantage of a high surgical morbidity and complications. As with any major surgical procedure, the best results are dependent on the experience and skill of the individual surgeon.

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Section: Bep (One Vs Two Cycles)mentioning

confidence: 84%

Section: Active Surveillancementioning

confidence: 99%

Current Concepts in Management of Stage I NSGCT

Ahluwalia

Gautam

2016

Indian J Surg Oncol

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“…Approximately 33% of all patients with stage 1 non-seminomas have LVI (19). Other important prognostic risk factors are a proliferation rate >70% and percentage of embryonal carcinoma >50%.…”

Section: Discussionmentioning

confidence: 99%

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

Aydın¹,

Bolat²,

Taşlı³

et al. 2018

uob

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IntroductionTesticular cancer accounts for 1-1.5% of all cancers in men and 5% of male urological malignancies. It is usually seen between the ages of 15 and 35. In the USA, it is the most common malignancy among men aged 20-40 years and the second most common malignancy after leukemia among adolescents aged 15-19 years. The prevalence of bilateral germ cell tumor (GCT) is 2.5%, with 0.6% of these being synchronous tumors and 1.9% being metachronous contralateral tumors (1).The vast majority (90-95%) of testicular tumors are GCTs. The most common histological type of GCT is seminoma (55%), which peaks between the ages of 30-40 years. Non-seminomas account for 40% and peak between the ages of 20-30 years (2). Stage 1 seminomas comprise the majority (80-85%) of GCTs diagnosed in daily practice (3,4). The 10-year overall Objective: Treatment modalities applied after orchiectomy in early-stage germ cell tumors (GCTs) include significant changes in each new study. In this study we reevaluated the treatment approaches used in our hospital between 2010-2014 according to current guidelines. Materials and Methods: We retrospectively evaluated the oncologic treatments and follow-up data of 32 patients who underwent radical orchiectomy between January 2010 and December 2014 due to testicular tumor and were diagnosed with early stage GCT in the Urology Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of University of Health Sciences. Results: Of 19 patients diagnosed with stage 1 seminomas, 3 patients in the low risk group were followed. Of 4 patients who received single-dose carboplatin therapy, 2 were at low risk and 2 were at high risk. Therefore, 2 patients at low-risk had overtreatment. Twelve patients were treated with radiotherapy (RT) that was no longer recommended in guidelines after 2014. Two patients in the low risk group of stage 1 non-seminoma were followed. One of them had recurrence at 12 months, and received 3 cycles of bleomycin + etoposide + cisplatin (BEP) according to current guidelines. Four patients with stage 1 non-seminoma underwent 2 cycles of BEP because they were considered at high risk. These patients are now recommended to receive 1 cycle BEP according to the current guidelines. While 4 patients with stage 1 mixed GCT were followed because of low risk, one patient was administered 2 cycle of BEP based on the old guidelines, at that time because of high risk. In the seminoma group that was administered RT, acute myeloblastic leukemia and oligospermia toxicity were detected, but these were not observed in the carboplatin group. One of high-risk non-seminoma patients who received 2 doses of BEP developed Myelodysplastic syndrome. Conclusion: Early-stage GCTs have high cancer-specific and overall survival rates with appropriate treatment approaches. Although there are still controversial issues regarding their management, treatment approaches are changing with each study. Therefore, it is crucial to remain informed about current international guidelines and...

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“…In our present prospective study, we observed the relapse rate 48/ 287 (16.7%) at a median follow-up of 7.0 months. Recent results of the SWENOTECA study [24] showed 258 LVI positive patients (follow-up 8.0 years) receiving one course of BEP 8 (3.2%) relapse with median time to relapse 1.1 years. Albers et al [25] reported results of the largest randomized trial (German Testicular Cancer Study Group) investigating adjuvant treatment strategies in CSI NSGCTT which showed 2/ 174 (1.2%) relapses following one course of BEP chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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SummarySurveillance after orchiectomy alone has become popular in the management of clinical stage I of nonseminomatous germ cell testicular tumors (CSI NSGCTT). Eff orts to identify patients at high-risk of relapse led to a search for risk factors in CSI NSGCTT. The aim of the current study was to analyze long-term experiences with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy). From 1/ 1992 to 2/ 2015, a total of 454 CSI NSGCTT patients were included in the study and stratifi ed into two groups according to risk-adapted therapeutic approaches. In Group A (low-risk CSI NSGCTT), which consisted of 287 patients who underwent surveillance, relapse occurred in 48 (16.7%) patients with a median follow-up of 7.0 months. Six patients (2.1%) of this group died with a median follow-up of 34.3 months. In Group B (high-risk CSI NSGCTT), which consisted of 167 patients who were treated with adjuvant chemotherapy, relapse occurred in two (1.2%) patients with a median follow-up of 56.2 months. One patient (0.6%) died 139.4 months following orchiectomy. Statistically signifi cant diff erence in progression free survival between these two groups was found, but no signifi cant diff erence in overall survival. Key words testicular cancer -surveillance -adjuvant chemotherapy -disease progression SúhrnPrísny dohľad po orchiektómii samotnej sa stal populárnym v manažmente neseminomatóznych germinatívnych nádorov testis v I. klinickom štádiu (clinical stage I nonseminomatous germ cell testicular tumors -CSI NSGCTT). Úsilie identifi kovať pa cientov s vysokým rizikom progresie ochorenia viedlo k vyhľadávaniu rizikových faktorov u CSI NSGCTT. Cieľom súčasnej štúdie bolo analyzovať dlhoročné skúsenosti s liečebnými postupmi založenými na prítomnosti rizikových faktorov (prísny dohľad a adjuvantná chemoterapia). V období 1/ 1992-2/ 2015 bolo celkovo 454 pa cientov s CSI NSGCTT zaradených do štúdie. Stratifi kovali sa do dvoch skupín podľa použitých liečebných postupov v závislosti na prítomnosti rizikových faktorov. Skupina A (CSI NSGCTT s nízkym rizikom) pozostávala z 287 pa cientov ktorí podstúpili prísny dohľad, progresia ochorenia sa zistila u 48 (16,7 %) pa cientov po mediáne sledovania 7,0 mesiacov. Šesť pa cientov (2,1 %) v tejto skupine zomrelo po mediáne sledovania 34,3 mesiacov. Skupina B (CSI NSGCTT s vysokým rizikom) pozostávala z 167 pa cientov, ktorí boli dostávali adjuvantnú chemoterapiu, progresia ochorenia sa zistila u dvoch pa cientov (1,2 %) s mediánom sledovania 56,2 mesiacov. Jeden pa cient (0,6 %) zomrel 139,4 mesiacov po orchiektómii. Štatisticky významný rozdiel medzi oboma skupinami sa zistil v prežívaní bez progresie ochorenia, avšak nevýznamný bol rozdiel v celkovom prežívaní. Klúčové slová testikulárne nádory -prísny dohľad -adjuvantná chemoterapia -progresia ochoreniaThis publication is the result of the implementation of project APVV-0016-11 supported by the Slovak Research and Development Agency.Práca bola podporená grantom Agentúry pre podporu výskumu a vývoja APVV -00...

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One course of adjuvant BEP in clinical stage I nonseminoma mature and expanded results from the SWENOTECA group

Cited by 125 publications

References 26 publications

Current Concepts in Management of Stage I NSGCT

Current Concepts in Management of Stage I NSGCT

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

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

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