Surveillance Study for Clinical Stage I Testicular Seminomas and Nonseminomatous Germ Cell Tumors

Suzuki, Kenichi; Orikasa, Seiichi; Hoshi, Senji; Yoshikawa, Kazuyuki; Imai, Yoshihiro; Aizawa, Mamoru; Nishimura, Yukio; Okada, Yasuhiro; Ohnuma, Tetsutaro; Ogata, Yukihiko

doi:10.1111/j.1442-2042.1998.tb00414.x

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…Of the 10 patients with stage I diseases (regarding contralateral tumors as the other events) who received surveillance policy (seven with seminoma, three with non‐seminoma), one patient with non‐seminoma relapsed, while no patients with seminoma suffered relapse. The relapsing incidence of stage I disease with surveillance policy was almost identical to usual unilateral GCTT 10 …”

Section: Resultsmentioning

confidence: 82%

Bilateral testicular tumors: A report of nine cases with long‐term follow‐up

et al. 2002

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Background: The incidence and clinical features of bilateral germ cell testicular tumor (GCTT) in the Japanese population are not fully characterized. We examined the incidence, clinical features, management and outcome, sexual status, hormonal environment, implication of androgen replacement, and human leukocyte antigen (HLA) typing of bilateral GCTT. Methods:We treated nine consecutive patients with bilateral GCTT from 1980 through to 1999, and reviewed their hospital and clinic charts. Testosterone, luteinizing hormone, follicle stimulating hormone, dehydroepiandrosterone, and dehydroepiandrosterone-sulfate were measured in bilateral orchiectomized patients. Human leukocyte antigen typing was assessed with peripheral lymphocyte.Results: The incidence of bilateral GCTT against the total number of patients with GCTT was 9/274 (3.3%). The median age of the first tumor was 29 (range 21-75) years. Three cases were synchronous and the remaining six cases were metachronous. In the case of metachronous tumor, the median interval between first and contralateral tumor was 8 (range 2-25) years. Standard treatment was defined as surveillance policy in stage I, chemotherapy for higher stages of non-seminoma, and radiotherapy for stage II seminoma. Human leukocyte antigen typing was examined for seven cases. Five cases were positive for HLA-A24. The incidence of HLA-A24 in bilateral GCTT was identical to that of the Japanese population. The relapsing incidence of stage I disease with surveillance policy was almost identical to unilateral GCTT. A 74-year-old patient with stage II seminoma died of the disease at 1.3 years. The other eight patients remained well without any evidence of recurrence at a median follow-up period of 78 (range 12-204) months. Four patients with bilateral orchiectomy did not require androgen replacement without easy fatigability. Sexual status was conserved using androgen replacement. Conclusions: Long-term follow-up, as long as 25 years, is recommended for contralatelral relapse. Some patients with bilateral orchiectomy do not require androgen replacement. The significance of HLA-A24 for bilateral testicular tumor is equivocal in the Japanese population.

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Section: Resultsmentioning

confidence: 82%

Bilateral testicular tumors: A report of nine cases with long‐term follow‐up

et al. 2002

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“…Irradiation of the para‐aortic and ipsilateral iliac lymph nodes has been the standard adjuvant treatment for many years. However, the excellent cure rate achieved by surveillance depends on the availability of effective salvage chemotherapy 18,19 . The benefit of adjuvant radiation is that it can reduce the relapse rate from 15 to 2%, while the benefit of surveillance unnecessary treatment can be avoided in approximately 85% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the excellent cure rate achieved by surveillance depends on the availability of effective salvage chemotherapy. 18,19 The benefit of adjuvant radiation is that it can reduce the relapse rate from 15 to 2%, while the benefit of surveillance unnecessary treatment can be avoided in approximately 85% of patients. However, follow-up of stage I SGCT patients managed by either adjuvant radiation or surveillance is difficult compared to that of NSGCT due to the relatively high frequency of late recurrence, lack of good serum marker, and variation of metastatic sites including extranodal metastases.…”

Section: Discussionmentioning

confidence: 99%

Follow‐up of clinical stage I testicular cancer patients: Cost and risk benefit considerations

2002

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Background: Regardless of the way it is managed, a high cure rate has been achieved for recurrent low-stage testicular cancer. Achieving a balance between survival and the patient's inconvenience and expense during follow-up, has therefore become an important issue. Methods: Prognoses and recurrence patterns were investigated in 39 patients with stage I nonseminomatous germ cell tumor of the testis (NSGCT), and 82 patients with stage I seminomatous germ cell tumor of the testis (SGCT), who underwent high orchiectomy between 1970 and 1997 at our institution. We considered the cost benefits and the risks by reviewing our results together with other reported results.Results: Patients with clinical stage I NSGCT under surveillance showed no progression later than 4 years after orchiectomy. The ability to detect progression using chest X-ray alone appeared very low. There was no infradiaphragmatic recurrence after adjuvant radiotherapy for patients with stage I SGCT. Only two of 204 patients showed progression, which included eight of our patients who underwent two cycles of adjuvant carboplatin therapy. Conclusions: Four years of intensive follow-up is probably sufficient for patients with stage I NSGCT under surveillance, and routine chest X-rays may be required only during the first year of surveillance. The benefit of using adjuvant radiotherapy for patients with stage I SGCT is that we could remove abdominal and pelvic CT scans from the routine follow-up protocol. Randomized trials will clarify whether the adjuvant carboplatin therapy is less toxic, provides better prognosis and is more cost-effective than adjuvant radiotherapy.

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“…11,12 Forty-four patients with stage I testicular tumor (24 with seminoma and 20 with NSGCT) were placed on close observation alone after radical orchiectomy (surveillance policy) and recurrences were found in 12 patients (two with seminoma and 10 with NSGCT). 13 These patients with a recurrence in stage I were restaged after the first recurrence and included in this study.…”

Section: Methodsmentioning

confidence: 99%

The significance of resections for residual masses after chemotherapy in metastatic testicular tumors

et al. 1999

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Background: After chemotherapy for metastatic testicular tumors, masses may remain, often in the metastatic sites. This study analyses the role of resections for the residual masses. Conclusions:Resection for residual masses after chemotherapy in metastatic testicular tumors was useful in confirming the tissue and in controlling the metastatic sites. Recurrences were often found in patients with cancer in the residual mass and the prognosis of patients with cancer was poor, therefore the development of more effective therapy for patients with cancer is required to improve the prognosis.

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Surveillance Study for Clinical Stage I Testicular Seminomas and Nonseminomatous Germ Cell Tumors

Cited by 9 publications

References 33 publications

Bilateral testicular tumors: A report of nine cases with long‐term follow‐up

Bilateral testicular tumors: A report of nine cases with long‐term follow‐up

Follow‐up of clinical stage I testicular cancer patients: Cost and risk benefit considerations

The significance of resections for residual masses after chemotherapy in metastatic testicular tumors

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