Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?

Harvey, Marjorie; Geldart, T.; Duell, Ryan; Mead, G. M.; Tung, Ken

doi:10.1093/annonc/mdf032

Cited by 55 publications

(29 citation statements)

References 18 publications

(19 reference statements)

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“…Thereareonlyafewpublicationsthathavefocusedonthe modalities of imaging in the follow-up of testicular cancers. 2retrospectivestudiesarenoteworthy [22,23]:…”

Section: Evidence For the Choice Of Imaging Modalitymentioning

confidence: 99%

“…Theotherpublication [23]hasraisedthequestionifaCT ofthethoraxisnecessaryorifstandardchestX-raysaresufficientforfollow-upofpatientswithstageInon-seminoma.In thisretrospectiveanalysis,tumorrecurrencewasdiagnosedin allcasesbyraisedtumormarkers,abdominaldisease,orvisiblemetastasesinconventionalimaging,suggestingthatanadditional chest CT would have been of little additional value [23] (level III, B).Therefore,wegenerallyrecommendchest X-rayinsteadofchestCTforroutinefollow-up.Thevalueof achestX-rayforpatientswithcompleteremissionaftertreatmentformetastaticnon-seminomahasbeenquestioned [25]. ThenumberofchestX-raysforthispatientgrouphasthereforebeenlargelyreduced.…”

Section: Evidence For the Choice Of Imaging Modalitymentioning

confidence: 99%

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Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Cathomas

Hartmann²,

Krege³

et al. 2011

Oncol Res Treat

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Over the last years, clear treatment recommendations for patients with testicular cancer have been published. This has led to significant improvements in outcome and survival. Moreover, active surveillance has become a cornerstone in the management of clinical stage I seminomatous and non-seminomatous germ cell tumors. On the other hand, the existing recommendations for the follow-up of testis cancer patients are unclear and differ widely. Follow-up recommendations in this young patient population have to be as evidence based as possible, feasible in order to ensure adherence, and must not be harmful. Therefore, attention has to be paid to the negative impact of unnecessary radiation exposure. Recently, new evidence became available regarding the relapse pattern of different disease stages of testicular cancer, the use of imaging at follow-up, and the risks of excessive radiation due to imaging, and in particular that of computed tomography (CT) scans. This article summarizes the recommendations for follow-up of testicular cancer patients of an interdisciplinary multinational working group consisting of urologists, medical oncologists, and radiation oncologists.

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“…Thereareonlyafewpublicationsthathavefocusedonthe modalities of imaging in the follow-up of testicular cancers. 2retrospectivestudiesarenoteworthy [22,23]:…”

Section: Evidence For the Choice Of Imaging Modalitymentioning

confidence: 99%

Section: Evidence For the Choice Of Imaging Modalitymentioning

confidence: 99%

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Cathomas

Hartmann²,

Krege³

et al. 2011

Oncol Res Treat

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“…Thoracic relapse rates of around 20% can be expected but methods of detection remain controversial, predominantly as drawing conclusions from small series is unreliable. From a series of 168 patients, 8/42 relapses (19%) occurred within the chest (Harvey et al, 2002), although 7 had other indicators of relapse (raised markers and abnormal abdominopelvic CT scans) and all 8 had abnormal chest radiographs, and the authors concluded that there is no requirement for thoracic CT. Some may go further -of 170 patients undergoing surveillance for stage I NS, all recurrences were detected with clinical history and examination, markers and abdominopelvic CT, and it was felt that the omission of chest radiographs would not have altered the outcome (Sharir et al, 1999).…”

mentioning

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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“…In one series (Harvey et al, 2002) with 168 patients on surveillance, eight developed thoracic metastases, all of which were visible on chest x-ray. Another study (Fernandez et al, 1994) highlighted the difference in sensitivity between chest x-ray and CT, comparing CT chest at initial diagnosis to chest x-ray in 117 patients with NSGCT.…”

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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Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?

Cited by 55 publications

References 18 publications

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

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

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

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