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Abstract
PURPOSE OF REVIEW Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications. RECENT FINDINGS At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma. SUMMARY Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.
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Affiliation(s)
- Jerusha Padayachee
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Roderick Clark
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Spinelli C, Cito G, Morelli G, Ghionzoli M, Bertocchini A, Sanna B, Galli L, Antonuzzo A, Morganti R, Strambi S. Testicular germ cells tumors in adolescents and young adults: Management and outcomes from a single-center experience. Arch Ital Urol Androl 2021; 93:301-306. [PMID: 34839629 DOI: 10.4081/aiua.2021.3.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate and compare the effectiveness of active surveillance versus post-surgical active treatment, in patients with testicular germ cells tumor (TGCT). MATERIALS AND METHODS We retrospectively analyzed 52 patients who underwent surgery for TGCT from January 2009 to December 2014. All the patients were divided into two age groups: the Group A included children-adolescents from 18 months to 21 years old, while the Group B comprised young adults from 22 to 39 years old. Clinical, histopathological, therapeutic and follow-up data were collected. RESULTS Overall, 22 patients (42,3%) were enrolled in the Group A and 30 patients (57.7%) were categorized in the Group B. Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed in 4 patients (7.7%). Post-surgical management differed based on clinical stage, resulting in active surveillance or adjuvant therapy. After an average 7 years follow-up period (range: 3.5-9.0 years), the overall survival rate is 100%. The relapse risk is significantly higher for the patients in the Group B, displaying a recurrence free-survival rate of 72% versus 95% (Group A); 11 relapses (21.1%) were recorded 2 years after surgery. Of these, 3 recurrences (12.0%) occurred in patients undergoing an active surveillance approach, while 8 (29.6%) in patients subjected to an active treatment. CONCLUSIONS The excellent prognosis in both age groups confirms the high curability of this neoplasia. The active surveillance could represent an optimal option for low recurrence risk tumors. However, post-surgical treatments should be taken into consideration for TGCT with high risk factors, including tumor size, lymphovascular and rete testis invasion.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Gianmartin Cito
- Department of Urology and Andrology Surgery, Careggi Hospital, University of Florence.
| | - Girolamo Morelli
- Department of Urology and Andrology Surgery, University of Pisa.
| | - Marco Ghionzoli
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Alessia Bertocchini
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Beatrice Sanna
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
| | - Luca Galli
- Medical Oncology II, University of Pisa, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Andrea Antonuzzo
- Medical Oncology I, National Health Service Department of Translational Medicine Research and New Technologies in Medicine and Surgery, University of Pisa.
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa.
| | - Silvia Strambi
- Division of Pediatric, Adolescents and Young Adults Surgery, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa.
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Radiotherapy in testicular germ cell tumours - a literature review. Contemp Oncol (Pozn) 2017; 21:203-208. [PMID: 29180926 PMCID: PMC5701577 DOI: 10.5114/wo.2017.69592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022] Open
Abstract
Testicular germ cell tumours (GCT) represent about 1-2% of malignant in men. The essential therapeutic option for early-stage GCT is radical orchiectomy (RO), except in situations that require immediate chemotherapy in patients with a massive dissemination and unequivocally elevated levels of tumour markers. Postoperative radiotherapy (PORT) in patients with testicular seminoma in Clinical Stage I (CS I) is one of the treatment options next to active surveillance (AS) and chemotherapy (CHTH). Regardless of the procedure, five-year survival in this group of patients ranges between 97% and 100%. In the article, we present the literature review pertinent to therapeutic options, with a focus on radiotherapy. We have searched MEDLINE (PubMed) for all studies on patients with GCT treated with radiation therapy during the last 20 years, and the current therapeutic recommendations. We used the following keywords: germ cell tumours, testis, seminoma, non-seminoma, radiotherapy, outcome.
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Glicksman R, Hamilton RJ, Chung P. Retroperitoneal hematoma following radical orchiectomy: Two cases. Can Urol Assoc J 2017; 11:E35-E37. [PMID: 28163811 PMCID: PMC5262509 DOI: 10.5489/cuaj.3996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Treatment of testicular cancer is dependent on the stage of disease at presentation. Stage 1 testicular cancer is treated with radical orchiectomy, followed by active surveillance, radiotherapy, or chemotherapy. Occasionally, unusual and unexpected postoperative changes can be seen on computed tomography (CT), and may raise concern for metastatic disease. Here, we present two cases of testicular cancer patients who developed retroperitoneal hematomas post-radical orchiectomy, one as a classical clinical presentation, and the other as an atypical radiological entity only. The first is a case of a 38-year-old male with a non-seminoma testicular cancer, who developed severe flank pain, hemodynamic instability, and progressive anemia from a retroperitoneal hematoma in the immediate (<24 hours) postoperative period, requiring urgent surgical evacuation. The second is a case of a 33-year-old male with a testicular seminoma who had a large, suspicious retroperitoneal mass on a staging CT scan concerning for metastatic disease, which was later diagnosed as a retroperitoneal hematoma. These cases reveal the clinical variability with which a retroperitoneal hematoma post-radical orchiectomy may present. In addition, the second case demonstrates the importance of recognizing radiological postoperative changes and ensuring that these findings are not mistaken for and treated as metastatic disease.
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Affiliation(s)
- Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Robert J. Hamilton
- Department of Surgery (Urology), University of Toronto, Toronto, ON, Canada
- Department of Surgery (Urology), Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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O'Kane D, D'Arcy FT, Papa N, Smith N, McClintock S, Lawrentschuk N, Bolton DM. Radiation dosing in the investigation and follow-up of urolithiasis: Comparison between historical and contemporary practices. Investig Clin Urol 2016; 57:113-7; discussion 118. [PMID: 26981593 PMCID: PMC4791672 DOI: 10.4111/icu.2016.57.2.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/20/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Computed tomography (CT) is the gold standard imaging modality for the diagnosis and follow-up of urolithiasis. Before the use of CT, intravenous urography (IVU) was the imaging modality of choice. CT remains contentious because of the cancer risk related to radiation exposure above a threshold level. We aimed to compare the radiation exposure dose to the average patient with urolithiasis in the era of CT with that of IVU. Materials and Methods Our hospital medical records database was searched for patients who presented to the Emergency Department over a 1-month period in 1990 with a diagnosis of renal colic. Patients with the same presentation, from the same month, in 2013 were also identified. A total of 14 patients from each year fulfilled the inclusion criteria. The estimated effective radiation exposure dose for each patient was calculated by using data from population-based studies. Results The median effective radiation dose per patient in the 1990 group, for initial diagnosis and subsequent follow-up, was 4.05 mSv (interquartile range [IQR], 3.7–4.4 mSv). The corresponding median dose in the 2013 group was 4.2 mSv (IQR, 4.2–4.9 mSv), and there was no evidence of a statistical difference between the groups (p=0.8). Conclusions Despite the contentiousness related to the use of serial CT scanning, our study demonstrated that for radiological investigation and follow-up of urolithiasis, the estimated effective radiation exposure dose to each patient is only marginally higher than in the era of IVU, with improvements in length of hospital stay and time to definitive diagnosis.
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Affiliation(s)
- Dermot O'Kane
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia.; Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Frank T D'Arcy
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nathan Papa
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Neil Smith
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Scott McClintock
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | | | - Damien M Bolton
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
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Hafeez S, Singhera M, Huddart R. Exploration of the treatment challenges in men with intellectual difficulties and testicular cancer as seen in Down syndrome: single centre experience. BMC Med 2015; 13:152. [PMID: 26123546 PMCID: PMC4485877 DOI: 10.1186/s12916-015-0386-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/03/2015] [Indexed: 01/07/2023] Open
Abstract
Down syndrome is the most common chromosomal disorder in humans as well as the most common cause of inherited intellectual disability. A spectrum of physical and functional disability is associated with the syndrome as well as a predisposition to developing particular malignancies, including testicular cancers. These tumours ordinarily have a high cure rate even in widely disseminated disease. However, individuals with Down syndrome may have learning difficulties, behavioural problems, and multiple systemic complications that have the potential to make standard treatment more risky and necessitates individualized approach in order to avoid unacceptable harm. There is also suggestion that tumours may have a different natural history. Further, people with learning disabilities have often experienced poorer healthcare than the general population. In order to address these inequalities, legislation, professional bodies, and charities provide guidance; however, ultimately, consideration of the person in the context of their own psychosocial issues, comorbidities, and possible treatment strategies is vital in delivering optimal care. We aim to present a review of our own experience of delivering individualized care to this group of patients in order to close the existing health inequality gap.
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Affiliation(s)
- Shaista Hafeez
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK. .,The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Mausam Singhera
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.,Guy's and St Thomas' NHS Foundation Trust, St Thomas Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Robert Huddart
- The Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK.,The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
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Abstract
Management of testicular seminoma has benefited from numerous advances in imaging, radiotherapy, and chemotherapy over the last 50 years leading to nearly 100% disease-specific survival for low-stage seminoma. This article examines the evaluation and management of low-stage testicular seminoma, which includes clinical stage I and IIA disease. Excellent outcomes for stage I seminoma are achieved with active surveillance, adjuvant radiotherapy, and adjuvant single-agent carboplatin. Current areas of research focus on optimizing surveillance regimens and minimizing the morbidity and long-term complications of adjuvant treatment. Radiotherapy continues to be the primary treatment option for patients with clinical stage IIa disease.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, Department of Surgery, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA.
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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Wood MJ, Tirumani SH, Sweeney C, Ramaiya NH, Howard SA. Approach to risk stratification in testicular germ cell tumors: a primer for radiologists. ACTA ACUST UNITED AC 2014; 40:1871-86. [DOI: 10.1007/s00261-014-0304-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Aparicio J. Positron emission tomography (PET) is not indicated in the postchemotherapy evaluation of advanced non-seminomatous testicular germ cell tumors. Clin Transl Oncol 2014; 16:509-10. [PMID: 24532306 DOI: 10.1007/s12094-014-1161-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 01/28/2014] [Indexed: 11/27/2022]
Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitari i Politècnic La Fe, Valencia, Spain,
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