Retroperitoneal Lymphadenectomy for Clinical Stage a Testis Cancer (1965 to 1989): Modifications of Technique and Impact on Ejaculation

Donohue, John P.; Thornhill, John; Foster, Richard S.; Rowland, Randall G.; Bihrle, Richard

doi:10.1016/s0022-5347(17)36046-9

Cited by 266 publications

(144 citation statements)

References 29 publications

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“…Such patients are typically offered 'adjuvant' chemotherapy in the form of two cycles of BEP with subsequent recurrences uncommon indeed (Donohue et al, 1993;Spermon et al, 2002;Albers et al, 2003). Patients without evidence of nodal metastases demonstrate relapse rates between 10 and 13%, the vast majority of which are pulmonary in nature and occur within the first year.…”

Section: Stages Iic -Ivmentioning

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: Stages Iic -Ivmentioning

confidence: 99%

“…Around 30% node-positive patients not receiving further treatment relapse (Donohue et al, 1993) and as such should be followed up along the NS stage I surveillance protocol, as should node-negative patients, although abdominal relapse post-RPLND should be uncommon.…”

Section: Nonseminoma 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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“…Nerve-sparing RLND (Jewett et al, 1988;Donohue et al, 1993) is a reasonable alternative to surveillance and does not usually lead to long-lasting sequelae. The operation represents, however, major surgery with 6-8 weeks' sick leave in most patients.…”

Section: Discussionmentioning

confidence: 99%

How safe is surveillance in patients with histologically low-risk non-seminomatous testicular cancer in a geographically extended country with limited computerised tomographic resources?

Fosså

Jacobsen²,

Aass

et al. 1994

Br J Cancer

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“…Following the failure of drug substitutions to convincingly reduce the toxicity of ACT, the next step was clearly to examine a single cycle of full dose (etoposide total dose 500 mg/sqM) BEP [58][59][60][61][62]. Very encouraging results were reported in the following two European studies:…”

Section: Bep (One Vs Two Cycles)mentioning

confidence: 99%

“…According to the EGCCCG and the EAU guidelines, in patients unwilling to undergo a surveillance strategy or adjuvant chemotherapy, nerve-sparing lymphadenectomy (NS-RPLND) may be performed [29,47,62].…”

Section: Retroperitoneal Lymph Node Dissectionmentioning

confidence: 99%

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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Retroperitoneal Lymphadenectomy for Clinical Stage a Testis Cancer (1965 to 1989): Modifications of Technique and Impact on Ejaculation

Cited by 266 publications

References 29 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

How safe is surveillance in patients with histologically low-risk non-seminomatous testicular cancer in a geographically extended country with limited computerised tomographic resources?

Current Concepts in Management of Stage I NSGCT

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