Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial

Oliver, R. T. D.; Mason,; Mead, G. M.; Maase, Hans von der; Rustin, G. J. S.; Joffe, Johnathan; Wit, Ronald de; Aass, Nina; Graham, John D.; Coleman, Robert E.; Kirk, S; Stenning, Sally

doi:10.1016/s0140-6736(05)66984-x

Cited by 412 publications

(240 citation statements)

References 25 publications

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“…Approximately, 75% of men who are diagnosed with seminoma have stage I disease, for which management options following orchidectomy consist of surveillance or adjuvant treatment in the form of either radiotherapy or, more recently, a single cycle of carboplatin chemotherapy (Oliver et al, 2005). The disease-specific survival for stage I disease approaches 99% independent of the management strategy used (Oldenburg et al, 2006).…”

Section: Seminoma Stage Imentioning

confidence: 99%

“…The use of a single cycle of carboplatin has been investigated by a number of groups (Dieckmann et al, 2000;Oliver et al, 2005). Most notably, Oliver et al reported a randomised trial of 1477 patients demonstrating no inferiority of a single cycle of carboplatin as compared with para-aortic radiotherapy with respect to disease-free and overall survival.…”

Section: Clinical Studiesmentioning

confidence: 99%

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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%

Section: Clinical Studiesmentioning

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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“…1 Now, there is also evidence for the role of single agent carboplatin as adjuvant therapy in high risk stage 1 seminoma. 5 It is critical for all stage 1 patients who choose to be followed on a surveillance protocol to attend all scheduled follow-up appointments and scans to ensure that potential recurrences are detected and treated early.…”

Section: Discussionmentioning

confidence: 99%

Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance

Yee¹,

Gabos

North³

et al. 2012

CUAJ

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We report cases of 2 pure seminoma patients who developed metastatic spinalcord compressions. One patient was diagnosed at age 33 years with stage 1seminoma and, after undergoing an orchidectomy, chose to be followed ona surveillance protocol. He was lost to follow-up and presented again 22months later with back pain, leg weakness and sensory loss when his diseaserecurred as a spinal cord compression. He was treated with urgent surgicaldecompression and subsequent standard chemotherapy. More than 2years posttreatment, he is disease-free with normal neurologic function inhis lower extremities. The second patient presented at age 44 years withback pain and rapid loss of leg strength and sensation. Investigations revealeda malignant cord compression with lymphatic and vertebral body metastases.On physical examination, the patient was found to have a 6-cm lefttesticular mass. He was treated with emergency radiotherapy to the regionof his cord compression followed by a left inguinal orchidectomy. Pathologyconfirmed a pure classic seminoma. Postoperatively, he received standardchemotherapy and eventually regained neurologic function in his legs. Althoughit is rare for malignant spinal cord compression to occur in seminoma patients—either as the initial presentation of disease or as a site of disease recurrencein stage 1 patients on surveillance—it is crucial to consider seminoma as apossible etiology in young men diagnosed with malignant spinal cord compressionbecause timely contemporary treatments for seminoma will cure mostof these patients and offer them excellent functional recovery.

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“…Under the ionising radiation (medical exposure) regulations (2001), there is a legal requirement to keep radiation dose as low as reasonably achievable, and the radiation exposure from a CT chest is approximately equivalent to 400 chest x-rays, equivalent to a risk of radiation-induced second malignancies of 1 in 2000 (RCR, 2003). If chemotherapy is increasingly used (Oliver et al, 2005); diagnostic imaging will assume greater importance. Chest CT has been established as the imaging modality of choice for staging patients with teratoma of the testis (Bradey et al, 1987).…”

Section: Discussionmentioning

confidence: 99%

CT of the chest can hinder the management of seminoma of the testis; it detects irrelevant abnormalities

et al. 2007

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To evaluate the role of chest CT in the initial staging of testicular seminomatous germ cell tumours. All patients referred to Addenbrooke's Hospital with testicular seminoma from 1 January 2000 to 31 December 2005 were included and case notes retrospectively reviewed. One hundred and eighty-two patients with testicular seminoma were identified, with a median age of 37 years (range 19–74). Most patients had stage I disease (86%). Twenty-four patients had abnormal abdominal CT findings. One hundred and fifty-eight had normal abdominal CT findings but, on initial staging, chest CT reported abnormalities in 13 patients, which, on further follow-up CT were deemed to be irrelevant to the diagnosis of seminoma. There was a further patient with a normal CT abdomen in whom chest CT detected obvious metastatic disease, which was seen on chest x -ray. Overall 18 cases required additional investigations and follow-up for abnormalities subsequently found to be benign. There was a false-positive rate of 10% for initial staging with chest CT. This is the largest reported series of staging CT chest in testicular seminoma. In all patients with normal abdominal CT, normal chest x -ray and abnormal chest CT, subsequent follow-up investigations demonstrated that the lung lesions were incidental findings.

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Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial

Cited by 412 publications

References 25 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

Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance

CT of the chest can hinder the management of seminoma of the testis; it detects irrelevant abnormalities

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