Surveillance in stage I nonseminomatous germ cell tumours of the testis

Zúñiga, Álvaro; Kakiashvili, David; Jewett, Michael A.S.

doi:10.1111/j.1464-410x.2009.08858.x

Cited by 28 publications

(12 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The panel recommends treating patients with stage I nonseminoma based on the presence or absence of risk factors known to be associated with an increased risk of relapse (LVI, invasion of the spermatic cord, or invasion of the scrotum). [35][36][37][38][39][40][41][42][43] However, regardless of risk factors, patients with stage I nonseminoma with normal postorchiectomy serum AFP and beta-hCG levels have 3 management options after orchiectomy: surveillance, 40,47,58,59 nerve-sparing RPLND, 60 or chemotherapy (1 cycle of bleomycin, etoposide and cisplatin [BEP]) 61,62 as primary treatment (see TEST-7, page 1532, and TEST-E, page 1545). The major difference in the management of low-risk and highrisk patients is that surveillance is preferred for patients with stage I nonseminoma without risk factors, whereas all 3 management options should be carefully considered when risk factors are present.…”

Section: Primary Treatment Of Nonseminoma Stage I Without Risk Factorsmentioning

confidence: 99%

Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Gilligan

Lin

Aggarwal

et al. 2019

Journal of the National Comprehensive Cancer Network

213

233

View full text Add to dashboard Cite

Testicular cancer is relatively uncommon and accounts for ,1% of all male tumors. However, it is the most common solid tumor in men between the ages of 20 and 34 years, and the global incidence has been steadily rising over the past several decades. Several risk factors for testicular cancer have been identified, including personal or family history of testicular cancer and cryptorchidism. Testicular germ cell tumors (GCTs) comprise 95% of malignant tumors arising in the testes and are categorized into 2 main histologic subtypes: seminoma and nonseminoma. Although nonseminoma is the more clinically aggressive tumor subtype, 5-year survival rates exceed 70% with current treatment options, even in patients with advanced or metastatic disease. Radical inguinal orchiectomy is the primary treatment for most patients with testicular GCTs. Postorchiectomy management is dictated by stage, histology, and risk classification; treatment options for nonseminoma include surveillance, systemic therapy, and nervesparing retroperitoneal lymph node dissection. Although rarely occurring, prognosis for patients with brain metastases remains poor, with .50% of patients dying within 1 year of diagnosis. This selection from the NCCN Guidelines for Testicular Cancer focuses on recommendations for the management of adult patients with nonseminomatous GCTs.

show abstract

Section: Primary Treatment Of Nonseminoma Stage I Without Risk Factorsmentioning

confidence: 99%

Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology

Gilligan

Lin

Aggarwal

et al. 2019

Journal of the National Comprehensive Cancer Network

213

233

View full text Add to dashboard Cite

show abstract

“…For example surveillance is a suitable option for early stage seminoma or CIS over radiotherapy or chemotherapy. 15 Further examples include the treatment of metastatic disease with nervesparing retroperitoneal lymph node dissection, 16 use of testicular prostheses to reduce cosmetic and psychologic effects, 17 or even radiotherapy rather than radical orchiectomy in selected cases. 18 Partial orchi ectomy repre sents another branch of GCT manage ment whereby morbidity (functional, cosmetic and psychological) is reduced.…”

Section: Germ Cell Tumorsmentioning

confidence: 99%

Organ-sparing approaches for testicular masses

2010

Self Cite

View full text Add to dashboard Cite

Organ-sparing approaches are currently practiced in urology for many malignancies. Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate. Furthermore, many testicular lesions detected clinically or by ultrasonography will be benign, in which case radical orchiectomy represents overtreatment. Partial orchiectomy for benign lesions allows preservation of endocrine and exocrine function, and reduced risk of local recurrence. However, selection criteria are not clear and one must always be suspicious that a GCT might exist. Carcinoma in situ that remains in the salvaged testicle is a challenge to treat. Radiation therapy is an option, although there is a high chance that patients will subsequently require hormonal replacement. Partial orchiectomy should be undertaken only in selected patients--men with bilateral testicular cancer or GCT in a solitary testis--if the size and location of the mass are amenable to surgery. Informed patient consent discussing radical orchiectomy as the gold standard is mandatory, and discussion of the risks associated with CIS and its treatment, as well as the need for androgen supplementation are paramount. Alternative strategies of organ preservation, such as radiotherapy, HIFU and chemotherapy, might be appropriate treatment options in the future. However, the safety and efficacy of these procedures needs to be demonstrated in comparison with partial orchiectomy in larger and prospective studies with longer follow-up.

show abstract

“…Carboplatin-based chemotherapy is one of the treatment option for high-risk patients [1,2,12]; however, in our study in which patients were monitored using MDCT, fewer than 10 % of Japanese patients with these high-risk factors experienced a recurrence in the observation period. Vascular invasion is a known risk factor for the presence of occult metastases in patients with NSGCT, 50 % of whom will relapse on a regimen of surveillance alone after orchiectomy [1,2,9,13], compared with 15-20 % in patients without vascular invasion. Recent guidelines recommend two cycles of adjuvant chemotherapy using bleomycin, etoposide, and cisplatin (BEP) for patients with vascular invasion [1,2].…”

Section: Discussionmentioning

confidence: 99%