Prognostic Factors for Relapse in Stage I Seminoma Managed by Surveillance: A Pooled Analysis

Warde, Padraig; Lena, Specht; Horwich, A.; Oliver, R. T. D.; Panzarella, Tony; Gospodarowicz, Mary K.; Maase, Hans von der

doi:10.1200/jco.2002.01.038

Cited by 519 publications

(342 citation statements)

References 23 publications

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“…However, as patients who relapse on surveillance are routinely cured with subsequent treatment, surveillance can be considered as an option for all patients with stage I disease. The overall crude relapse rate for patients managed with surveillance is 15.2 -19.3% (Chung et al, 2002;Warde et al, 2002;Choo et al, 2005;Oldenburg et al, 2006). Most relapses occur in the first 2 years with a 45% annual hazard rate (AHR); relapses after 2 years are rare but are reported to occur up to 6 years after initial diagnosis Oldenburg et al, 2006).…”

Section: Seminoma Stage Imentioning

confidence: 99%

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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Testicular germ cell tumours (TGCTs) are the most common cause of cancer in men between the ages of 15 and 40 years, and, overall, the majority of patients should expect to be cured. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma and nonseminomatous germ cell tumours. There is, however, no international consensus on how best to follow patients after their initial management. This must promptly and reliably identify relapses without causing further harm. The standardising of follow-up would result in optimising risk-benefit ratios for individual patients, while ensuring economic use of resources. We have identified the seven common scenarios in managing seminomas and nonseminomas of the various stages and discuss the pertinent issues around relapse and follow-up. We review the available literature and present our comprehensive TGCT follow-up guidelines. Our protocols provide a pragmatic, easily accessible user-friendly basis for other centres to use or to adapt to suit their needs. Furthermore, this should enable future trials to address specific issues around follow-up giving meaningful and useful results. BackgroundTesticular germ cell tumours (TGCTs) are uncommon malignancies but the most common cause of cancer in men between the ages of 15 and 40 years. The peak incidence for nonseminomatous germ cell tumour (NSGCT) is between 20 and 30 years of age, and for seminoma between 30 and 40 years. In the United Kingdom, the incidence rate is only 1 : 100 000 men per year with a lifetime risk of developing a TGCT of 1 in 400 and 1900 new cases per year (Horwich, 2002). There has, however, been a steady increase in the incidence of TGCTs in European countries in the last two decades (Bergstrom et al, 1996). The reasons for this increasing incidence and the aetiology of TGCTs remain unknown. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma tumour and NSGCT (Schmoll et al, 2004). There is, however, a lack of clear consensus on how to follow patients after primary treatment, and a number of issues dictate that follow-up should be carefully thought out and rigorously adhered to. Here, we discuss these factors as they pertain to male germ cell tumour (GCT) practice and describe our recently developed protocols. Rational for follow-upDetecting relapse In general, detecting relapse is the major reason for maintaining follow-up and is the main focus of this review. The management of testicular cancer has been a major oncological success story, and provides a model for the management of curative solid tumours (Horwich et al, 2006). The use of platinumbased chemotherapy schedules has resulted in high cure rates for all stages of the disease (International Germ Cell Cancer Collaborative Group, 1997). The fact that the majority of young men treated for testicular cancer have a durable response to primary treatment has resulted in the accumulation of significant data on both the patterns ...

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Section: Seminoma Stage Imentioning

confidence: 99%

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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“…Therefore, follow-up should include patients with no risk factors (7,21). The problem with follow up is the number of patients who come to the control examination irregularly.…”

Section: Resultsmentioning

confidence: 99%

“…The adjuvant therapy is successful in 96 % to 100 % of patients (4,7,8). Many studies suggest that carboplatin is not inferior to adjuvant radiotherapy in preventing metastatic relapse.…”

Section: Abstract: Early Stage Seminoma Follow-up Para-aortic Radimentioning

confidence: 99%

Side Effects of Adjuvant Radiotherapy in Men with Testicular Seminoma Stage I

Gamulin

Grgić

Bišof

2011

Archives of Industrial Hygiene and Toxicology

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In this study we followed up the side effects of adjuvant radiotherapy in patients with testicular seminoma stage I over a period from 13 to 84 months (median 28 months). The most frequent side effects during radiotherapy were gastrointestinal (nausea/vomiting), psychological, cognitive, and minor sexual problems. The reported side effects were treated by antiemetics and anxiolytics. After radiotherapy, the side effects persisted in 6 % of patients, but only a few of them required additional treatment. Healthy children were born to 76 % of patients in the 18 to 39 years age group. This study shows that adjuvant radiotherapy of the para-aortic lymph nodes with the total dosage of 24 Gy in 16 daily fractions administered to testicular seminoma patients causes acceptable side effects, does not adversely affect quality of life and fertility, if the approach to treatment is individual and family consulting is provided. This makes adjuvant radiotherapy of the para-aortic lymph nodes an acceptable treatment for testicular seminoma stage I patients. Testicular germ cell tumours are relatively rare, appearing in 1 % of all tumours in male patients (1). Most of these tumours originate in germ cells (seminoma and non-seminoma germ cell testicular tumours, sometimes the combination of these two groups), and more than 70 % of patients are diagnosed the disease while it is still in stage I. These malignancies represent the most common solid tumours in young men aged 25 to 35 years and are highly curable. KEY WORDS: early stage seminoma, follow-up, para-aortic radiotherapy, quality of life, radiation toxicityPure seminoma is the most common variant of testicular germ cell tumours, accounting for in about 40 % of all cases. Seminoma is highly radiosensitive and chemosensitive (2). Adjuvant radiotherapy of the para-aortic lymph nodes after orchidectomy is one of the three approaches to management, which include surveillance, adjuvant radiotherapy (infradiaphragmatic 20 Gy to 25 Gy to include the para-aortic nodes), and adjuvant chemotherapy with carboplatin with area under the curve =7, (AUC=7) x 1 cycle or AUC=7 x 2 cycles (3-6).Many surveillance studies suggest that 15 % to 20 % of these patients develop a metastatic disease. The adjuvant therapy is successful in 96 % to 100 % of patients (4,7,8). Many studies suggest that carboplatin is not inferior to adjuvant radiotherapy in preventing metastatic relapse. The estimation of the therapy success, however, should include the quality of life during as well as after therapy. To improve the quality of life , it is therefore advisable to know which side effects to expect and how to prevent them).

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“…11 A recent meta-analysis of four studies (638 patients) identified potential risk factors for relapse on surveillance after orchidectomy. 12 Large primary tumor size, invasion of the rete testis and vascular invasion were identified on univariate analysis, with vascular invasion being excluded on multivariate analysis. Patients with both rete testis invasion and a primary tumor size > 4 cm had a 31.5% relapse risk, whilst patients with no risk factors had a 12% relapse rate.…”

Section: Discussionmentioning

confidence: 99%

Pelvic recurrence in stage I seminoma: A new phenomenon that questions modern protocols for radiotherapy and follow‐up

et al. 2005

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Objective : To highlight the increased risk for pelvic relapse in patients with stage 1 seminoma treated with adjuvant radiotherapy limited to para-aortic template alone. Patients and methods : Over a four-year period, three patients presented with early pelvic recurrence after radical orchidectomy and adjuvant irradiation for stage 1 seminoma. In each case, radiotherapy had been limited to the para-aortic region with omission of the ipsilateral hemi pelvis.Results : Pelvic recurrences occurred on the ipsilateral tumor side. Durable complete remission was achieved in each case; however, treatment was complex and there was associated morbidity. Conclusion : This significant incidence of pelvic recurrence questions the validity of modern radiotherapy protocol which excludes the ipsilateral pelvis from the radiation field.

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Prognostic Factors for Relapse in Stage I Seminoma Managed by Surveillance: A Pooled Analysis

Cited by 519 publications

References 23 publications

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Side Effects of Adjuvant Radiotherapy in Men with Testicular Seminoma Stage I

Pelvic recurrence in stage I seminoma: A new phenomenon that questions modern protocols for radiotherapy and follow‐up

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