Patterns of Disease Progression and Outcome of Patients With Testicular Seminoma Who Relapse After Adjuvant or Curative Radiation Therapy

Terbuch, Angelika; Posch, Florian; Bauernhofer, Thomas; Jost, Philipp J.; Partl, Richard; Stranzl-Lawatsch, Heidi; Baciarello, Giulia; Fizazi, Karim; Giannatempo, Patrizia; Verzoni, Elena; Sweeney, Christopher; Ravi, Praful; Basso, Umberto; White, Jeff; Vincenzi, Bruno; Oing, Christoph; Cutuli, Hernan Javier; Dieckmann, K.; Gamulin, Marija; Chovanec, Michal; Fankhauser, Christian Daniel; Heidenreich, Axel; Mohamad, Osama; Thibault, Constance; Fischer, Stefanie; Gillessen, Silke

doi:10.1016/j.ijrobp.2022.03.021

Cited by 2 publications

(2 citation statements)

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“…Our findings are in line with many studies on childhood cancer survivors, whose excess mortality is attributable to their primary and subsequent primary cancers and, to a lesser extent, to other non‐neoplastic causes 5,14,15,24 . In our cohort too, patients’ primary cancers continued to be the main cause of mortality even after 5 years (most likely due to late relapses), 25 alongside subsequent multiple tumors (Table S3). Subsequent primary cancers may share the same etiology and/or relate to late effects of treatments 22,26–29 …”

Section: Discussionsupporting

confidence: 90%

Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort

Trama

Bernasconi

Botta

et al. 2022

Pediatric Blood & Cancer

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Background Data on late mortality from pediatric germ cell tumors (GCTs) are limited to small case series. Our population‐based study aimed to investigate excess risk of death in survivors of GCT in childhood and adolescence, whether long‐term mortality changed over time and by period of diagnosis. Methods The PanCare Childhood and Adolescent Cancer Survivor Care and Follow‐Up Studies (PanCareSurFup) cohort includes 2773 five‐year survivors diagnosed under 21 years of age with gonadal and extragonadal GCT (from 1940 to 2008). We calculated standardized mortality ratios (SMRs) and absolute excess risks (AERs). We fitted a Cox's model to assess the impact of treatment period. We estimated 10‐year survival and calculated average percentage changes between periods of diagnosis (1970–1979, 1980–1989, 1990–1999) to assess whether late mortality decreased. Results GCT survivors had an almost four‐fold excess risk of dying compared to general population. The risk of death for patients treated after 1980 was nearly halved compared to patients treated before 1980. Survivors diagnosed in 1990–1999 had a 10‐year survival rate of 99%, which was 2.4% and 1.1% higher than for patients treated in 1970–1979 and 1980–1989, respectively. Conclusions This is the largest population‐based study in Europe and showed a decrease in long‐term mortality for survivors of GCTs in childhood and adolescence over the last decades. After the introduction of platinum compound in 1980, which is a paradigm of success compared to the previous treatments, no major changes in drug therapies have been made to treat GCTs in the last 40 years. However, GCT survivors maintain an excessive risk of death that requires long‐term care.

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Section: Discussionsupporting

confidence: 90%

Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort

Trama

Bernasconi

Botta

et al. 2022

Pediatric Blood & Cancer

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“…This preponderance of lymphatic and retroperitoneal/pelvic recurrences is similar to described patterns after regional RT in seminoma and in the PRIMETEST trial. 30,37 This pattern differs from that seen with primary RPLND in NSGCT, where retroperitoneal recurrences are uncommon, but should still draw attention to propensity of seminoma to spread via lymphatic channels and local tissue planes. 35 In both our study and PRIMETEST, there are a limited number of recurrences, which makes it difficult to draw firm conclusions on clinical or surgical factors that may contribute to this.…”

Section: Discussionmentioning

confidence: 97%

Surgery in Early Metastatic Seminoma: A Phase II Trial of Retroperitoneal Lymph Node Dissection for Testicular Seminoma With Limited Retroperitoneal Lymphadenopathy

Daneshmand

Cary

Masterson

et al. 2023

JCO

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PURPOSE The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors with minimal late morbidity although little data exist on its efficacy in early metastatic seminoma. Surgery in early metastatic seminoma is a prospective phase II single-arm, multi-institutional trial of RPLND as first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy. PATIENTS AND METHODS Twelve sites in the United States and Canada prospectively enrolled adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm). Open RPLND was performed by certified surgeons with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. RESULTS A total of 55 patients were enrolled, with a median (IQR) largest clinical lymph node size of 1.6 cm (1.3-1.9). RPLND pathology demonstrated a median (IQR) largest lymph node size of 2.3 cm (0.9-3.5); nine patients (16%) were pN0, 12 (22%) pN1, 31 (56%) pN2, and 3 (5%) pN3. One patient received adjuvant chemotherapy. With a median (IQR) follow-up of 33 months (12.0-61.6), 12 patients experienced recurrence, with a 2-year RFS of 81% and a recurrence rate of 22%. Of the patients who experienced recurrence, 10 were treated with chemotherapy and two underwent additional surgery. At last follow-up, all patients who experienced a recurrence were disease-free and the 2-year overall survival was 100%. Four patients (7%) experienced short-term complications, and four patients experienced long-term complications including incisional hernia (1) and anejaculation (3). CONCLUSION RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.

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Patterns of Disease Progression and Outcome of Patients With Testicular Seminoma Who Relapse After Adjuvant or Curative Radiation Therapy

Cited by 2 publications

References 39 publications

Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort

Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort

Surgery in Early Metastatic Seminoma: A Phase II Trial of Retroperitoneal Lymph Node Dissection for Testicular Seminoma With Limited Retroperitoneal Lymphadenopathy

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