The incidence, prognosis, clinical and histological characteristics, treatment, and outcome of patients with bilateral germ cell testicular cancer in Hungary

Abstract

Purpose: To examine the incidence, prognosis, clinical and histological characteristics, treatment, and outcome of patients with bilateral testicular cancer in the referral center in Hungary, to determine which parameters might predict a second testicular tumor. Methods: Clinical parameters-such as time of original surgery, histology of primary tumor, extent of the disease, serum marker concentrations, history of testicular abnormalities, treatment, response to treatment, followup period, data on second carcinoma-of bilateral testicular tumors among the 2,386 patients with testicular cancer treated between November 1988 and November 1998 were analyzed. Results: The incidence of patients with synchronous testicular tumor was 0.8% (19 of 2,386 patients). The clinical stages were 8 I/A, 5 I/B, 1 II/A, 2 II/ B, 1 III/A, and 2 III/B. Median follow-up time was 93 months and the 5-year overall survival was 84%. The incidence of patients with metachronous testicular cancer (median age 28 years and 35 years at first and second tumor diagnosis) was 2.2% (53 of 2,386 patients) and the median time to second tumor was 76 months (range 18-203 months). The clinical stages at the first and second tumor diagnosis were: 14 I/A, 21 I/B, 15 II/A, 2 II/B, and 1 III/B, and 26 I/A, 16 I/B, 3 II/A, 1 II/B, 7 III/B, respectively. The median follow-up time was 42 months and the 5-year overall survival was 93%. In thirteen patients with metachronous cancers, two family histories of testicular cancer, five cases of undescended testicles, seven cases of testicular atrophy, and one case of azoospermia were detected. There was a non-significant trend to a longer cancer interval after chemotherapy and radiotherapy and a tendency to a greater incidence of asynchronous seminoma after chemotherapy. Clinical stage I tumors were more frequent in the surveyed group than among patients not followed up according to the institutional protocol (P = 0.01), but the survival rate was good in both groups. Seminoma as a second tumor was diagnosed in an older age group (median 38 years, range 25-49 years) than nonseminoma (median 32 years, range 21-51 years, P < 0.045).The interval till the appearance of a metachronous testicular cancer depended on tumor histology: in seminoma cases it was longer than in nonseminoma cases (median time: 121 months versus 50 months, P = 0.002). Conclusions: The overall incidence of bilateral testicular cancer in the referral center in Hungary was 3%. We could not identify clinical factors which predicted a higher risk for metachronous testicular cancer. With regular follow-up the early diagnosis of second testicular tumors is probable; therefore education, self-examination of the remaining testicle, and long-term follow-up are important in early detection.

Sequential bilateral testicular tumours presenting with intervals of 20 years and more

“…Accordingly, it took 36 years for the remaining TIN cells to recover and to finally progress to invasive seminoma. In fact, there is some indication of extended intervals in bilateral GCTs following chemotherapy [13,15]. Our patient apparently represents the case with the longest lag time between sequential bilateral testicular tumours and interval chemotherapy.…”

“…In a French analysis, 23% of second tumours occurred between the 10 th and the 20 th year of follow-up [12], while no case developed later. All of the major investigations on bilateral testicular tumours accord with the contention, that the risk is high during the first ten years and that it is gradually decreasing thereafter forming an asymptotical curve approaching the zero line of risk beyond the 20 years mark [5,13-15]. As a matter of fact, this understanding implicates the sporadic occurrence of such tumours at exceptionally late time points.…”

“…Concerns regarding the low sensitivity of chemotherapy to eradicate the precursor in the contralateral gonad had been raised already in the 1980ies [37]. Accordingly, large series of patients with bilateral testicular tumours clearly revealed that chemotherapy does not protect against second tumours [4,15]. In the largest investigation of bilateral tumours performed on the SEER data base, 39 second tumours (> 1%) were found among 3157 nonseminoma patients receiving chemotherapy [35].…”

Synchronous bilateral testis cancer: clinical and oncological management

“…[4] and by the National Institute of Oncology in Hungary [11] represent an exception because they report that most patients in the synchronous tumour group presented with low-stage disease, respectively, 60% (6 of 10) and 68% (13 of 19).…”

Adjuvant Radiotherapy for Synchronous Bilateral Testicular Seminoma: A Case Report and a Review of the Pertinent Literature

“…Of the synchronous presentations of BGCT, it is quite rare to see a presentation of stage I synchronous concordant seminoma in both testes, as indicated in Table 2 [2–4, 6, 7, 9–12]. Most of these patients have been managed initially with bilateral orchiectomy, followed by adjuvant radiation therapy.…”