Radiotherapy of testicular intraepithelial neoplasia (TIN): a novel treatment regimen for a rare disease

Sedlmayer, Felix; Höltl, W.; Kozak, Walter; Hawliczek, R.; Gebhart, Florian; Gerber, Erich; Joos, H.; Albrecht, Walter; Pummer, Karl; Kogelnik, H.D.

doi:10.1016/s0360-3016(01)01483-3

Cited by 31 publications

(21 citation statements)

References 29 publications

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“…Two major studies yielded conflicting results [14,31]. Possibly, hyperfragmentation of irradiated dosage may afford both an efficacious and less toxic treatment of TIN [49]. Based on the present results, the 20 Gy regimen appears to be an appropriate standard until further data become available [12].…”

Section: Discussionmentioning

confidence: 83%

Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: A survey of the German Testicular Cancer Study Group

et al. 2013

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Section: Discussionmentioning

confidence: 83%

Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: A survey of the German Testicular Cancer Study Group

et al. 2013

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“…At the outset of the present study, the expectation based on the cumulative international experience (Giwercman et al, 1991;Mumperow et al, 1992;Dieckmann et al, 1993;Classen et al, 1998;Kazem and Danella, 1999;Sedlmayer et al, 2001) A feasible explanation would be the hypothesis that some of the TIN cells in the present patient were somehow radioresistant and thus escaped eradication. Presumably, in the present patient a few TIN cells had been present even at the 6-month checkpoint.…”

Section: Discussionmentioning

confidence: 86%

“…Accordingly, Sedlmayer et al (2001) reported the efficacy of a 13 Gy total dose applied in 10 fractions to eradicate TIN at least in a short time to follow-up and in a small cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group

Claßen

Dieckmann²,

Bamberg

et al. 2003

Br J Cancer

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Low-dose radiotherapy to the testis is effective in eradicating testicular intraepithelial neoplasia (TIN, carcinoma in situ of the testis) at the risk of androgenic deficiency. The present trial was designed to define the lowest dose effective to control TIN assuming a doseresponse relation of radiation-induced endocrinological damage. Patients with TIN in a solitary testicle or with bilateral TIN were treated with 18 Gy (14 patients) and 16 Gy (26 patients) (5 Â 2 Gy per week). Biopsies to ascertain clearance of TIN were performed after 6 and 24 months. The median time of follow-up is 20.5 months. There were three adverse events. In one patient, relapse of TIN along with microinvasive seminoma was observed 2 years after 16 Gy irradiation. In two other patients, persistent spermatogonia were observed with the 16 and 18 Gy regimen after 6 and 24 months, respectively. All other post-treatment biopsies showed the Sertoli cell-only pattern. These results confirm that TIN is a radiosensitive lesion efficiently controlled in most cases with doses below 20 Gy. However, sporadic failures may occur. A dose of 16 Gy is probably unsafe and should no longer be used. Future investigations should not only focus on total dosage of irradiation but also on fractionation schedules.

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“…Whether all patients with germ-cell intratubular neoplasia should receive radiotherapy to the contralateral testis remains debatable. The extent of radiotherapy in this indication is also controversial, (Classen et al, 2000;Sedlmayer et al, 2001;Petersen et al, 2002). Delivering doses below 20 Gy is not considered safe and local relapses have been reported even at this dose (Dieckmann et al, 1993(Dieckmann et al, , 1999(Dieckmann et al, , 2002.…”

Section: Discussionmentioning

confidence: 99%

Bilateral germ-cell tumours: 22-year experience at the Institut Gustave Roussy

et al. 2004

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The aim of this study was to describe the incidence, clinical and histological characteristics, treatment and long-term follow-up of bilateral germ-cell tumours (BGCT) of the testis in order to determine in what respects they differ significantly from unilateral germcell tumours. In all, 31 patients with BGCT had metachronous tumours and 14 had synchronous tumours. Among the metachronous tumours, 61% occurred more than 5 years after the first tumour. The overall incidence of BGCT in patients with testicular germ-cell tumours (TGCT) was 1.9%. The incidence was 3.2% in patients presenting with a seminoma and 1.4 % in patients presenting with a nonseminomatous germ-cell tumour (NSGCT). Patients under 30 years of age at the time of the initial diagnosis had a higher incidence of bilateral tumours compared with older men. The outcome of BGCT was excellent. A high association was found between BGCT, sterility and suspected genetic risk factors for TGCT. These results argue against a systematic contralateral biopsy at diagnosis of first TGCT in all patients, but emphasise the importance of patient education and of the need to better identify patients at risk for a second TGCT. Therapeutic indications for synchronous BGCT, including conservative treatment, need to be better defined. Testicular germ-cell tumour (TGCT) is a rare disease with an estimated incidence of five out of 100 000. An increase of more than 50% has been demonstrated in all Western countries during the last decades (Grenlee et al, 2001). Several risk factors for developing a TGCT have been identified, uppermost among which is a previous TGCT (Osterlind et al, 1991). The incidence of bilateral testicular germ-cell tumour (BGCT) ranges between 1 and 5% in previously published large series (Bokemeyer et al, 1993;Dieckmann et al, 1993Dieckmann et al, , 1999Dieckmann et al, , 2002Heidenreich et al, 1995Heidenreich et al, , 1997Heidenreich et al, , 2000Gerl et al, 1997;Tekin et al, 2000;Geczi et al, 2001;Ondrus et al, 2001;Che et al, 2002;Ohyama et al, 2002). The charts of 2383 consecutive patients treated at the Institut Gustave Roussy over a 22-year period were analysed to estimate the incidence of BGCT, to identify potential risk factors and to evaluate the long-term survival of patients with BGCT. PATIENTS AND METHODSBetween 1979 and 2002, 2383 patients with TGCT were treated in the Adult Cancer Department at the Institut Gustave Roussy (IGR). The list of patients was obtained from a computerised database. Among these 2383 patients, 45 had a BGCT. The medical records of these 45 patients were reviewed to collect the following information: previous personal and family medical history, clinical characteristics at presentation, histopathology, treatment, interval between the development of the two tumours and follow-up.All available pathology slides were reviewed. Most patients had their orchidectomy at other institutions. Haematoxylin-and eosinstained slides of both testicular tumours were available for 36 patients, and slides of only one tumour were avai...

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Radiotherapy of testicular intraepithelial neoplasia (TIN): a novel treatment regimen for a rare disease

Cited by 31 publications

References 29 publications

Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: A survey of the German Testicular Cancer Study Group

Treatment of testicular intraepithelial neoplasia (intratubular germ cell neoplasia unspecified) with local radiotherapy or with platinum-based chemotherapy: A survey of the German Testicular Cancer Study Group

Radiotherapy with 16 Gy may fail to eradicate testicular intraepithelial neoplasia: preliminary communication of a dose-reduction trial of the German Testicular Cancer Study Group

Bilateral germ-cell tumours: 22-year experience at the Institut Gustave Roussy

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