Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report.

Cullen, M. H.; Stenning, Sally; Parkinson, M. C.; Fosså, Sophie D.; Kaye, Stanley B.; Horwich, A.; Harland, Stephen; Williams, Michael; Jakes, Rupert

doi:10.1200/jco.1996.14.4.1106

Cited by 294 publications

(131 citation statements)

References 18 publications

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“…This has been shown to reduce the rate of relapse to o5% (Cullen et al, 1996). The proven GCT relapses seen in this trial occurred after 7 months and were detected by raised markers, and a published review including 148 patients treated with adjuvant chemotherapy demonstrated six (4%) relapses, all within 2 years of treatment .…”

Section: Nonseminoma Stage Imentioning

confidence: 63%

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: Nonseminoma Stage Imentioning

confidence: 63%

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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“…Cullen et al reported on outcomes of 114 patients with high-risk stage A NSGCT who were treated with 2 courses of combined bleomycin, etoposide, and cisplatin. 10 At a median follow-up of 4 years, there were 2 recurrences, 1 at 7 months in the retroperitoneum, liver, and lung and the other at 18 months in the groin. Other series have reported similar success with longterm follow-up.…”

Section: Discussionmentioning

confidence: 99%

Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor?

Beck

Foster

Bihrle

et al. 2007

Cancer

105

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BACKGROUND. Traditionally, postchemotherapy (PC) surgery for metastatic nonseminomatous germ cell tumor (NSGCT) has used a full bilateral retroperitoneal lymph node dissection (RPLND) from the crus of the diaphragm to the bifurcation of the common iliac arteries, from ureter to ureter. With the primary landing zone well defined in low‐volume retroperitoneal disease, the authors performed modified dissections in the PC setting in a select population; and, herein, they report disease outcome. METHODS. From 1991 to 2004, a retrospective review of the testicular cancer database at the authors' institution was performed to identify patients with NSGCT, normal serum tumor markers after cisplatin‐based chemotherapy, and residual retroperitoneal tumor who underwent modified PC‐RPLND. All patients had metastatic disease at initial presentation that was limited to the primary landing zone (left or right). RESULTS. One hundred patients were identified, including 43 who underwent a right modified template, 18 patients who underwent a left full modified template, and 39 patients who underwent a left modified template. Pathology revealed cancer in 2% of patients, teratoma in 62% of patients, and necrosis in 36% of patients. The 2‐ and 5‐year disease‐free survival rate was 95%, and the median follow‐up was 31.9 months (range, 1–152 months). Four patients developed recurrent disease with a median time to recurrence of 8.25 months (range, 6–11 months). All recurrences were outside the boundaries of a full bilateral RPLND. CONCLUSIONS. Selected patients at PC surgery can be managed with modified PC‐RPLND. Cancer 2007. © 2007 American Cancer Society.

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“…39,48,65,[71][72][73][74][75] Because the RCT compared adjuvant chemotherapy to RPLND, only the chemotherapy arm was included in the meta-analysis. Although the follow-up times of the included studies varied, all had sufficient follow-up that almost all recurrences that would occur among these patients were included.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

Canadian consensus guidelines for the management of testicular germ cell cancer

Wood

Kollmannsberger

Jewett

et al. 2013

CUAJ

123

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Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: a Medical Research Council report.

Cited by 294 publications

References 18 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

Is full bilateral retroperitoneal lymph node dissection always necessary for postchemotherapy residual tumor?

Canadian consensus guidelines for the management of testicular germ cell cancer

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