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Moss E, Taylor A, Andreou A, Ang C, Arora R, Attygalle A, Banerjee S, Bowen R, Buckley L, Burbos N, Coleridge S, Edmondson R, El-Bahrawy M, Fotopoulou C, Frost J, Ganesan R, George A, Hanna L, Kaur B, Manchanda R, Maxwell H, Michael A, Miles T, Newton C, Nicum S, Ratnavelu N, Ryan N, Sundar S, Vroobel K, Walther A, Wong J, Morrison J. British Gynaecological Cancer Society (BGCS) ovarian, tubal and primary peritoneal cancer guidelines: Recommendations for practice update 2024. Eur J Obstet Gynecol Reprod Biol 2024; 300:69-123. [PMID: 39002401 DOI: 10.1016/j.ejogrb.2024.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | | | - Adrian Andreou
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Christine Ang
- Northern Gynaecological Oncology Centre, Gateshead, UK
| | - Rupali Arora
- Department of Cellular Pathology, University College London NHS Trust, 60 Whitfield Street, London W1T 4E, UK
| | | | | | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Lynn Buckley
- Beverley Counselling & Psychotherapy, 114 Holme Church Lane, Beverley, East Yorkshire HU17 0PY, UK
| | - Nikos Burbos
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital Colney Lane, Norwich NR4 7UY, UK
| | | | - Richard Edmondson
- Saint Mary's Hospital, Manchester and University of Manchester, M13 9WL, UK
| | - Mona El-Bahrawy
- Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | | | - Jonathan Frost
- Gynaecological Oncology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, Bath BA1 3NG, UK; University of Exeter, Exeter, UK
| | - Raji Ganesan
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham B15 2TG, UK
| | | | - Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Whitchurch, Cardiff CF14 2TL, UK
| | - Baljeet Kaur
- North West London Pathology (NWLP), Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London and Barts Health NHS Trust, UK
| | - Hillary Maxwell
- Dorset County Hospital, Williams Avenue, Dorchester, Dorset DT1 2JY, UK
| | - Agnieszka Michael
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX and University of Surrey, School of Biosciences, GU2 7WG, UK
| | - Tracey Miles
- Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath BA1 3NG, UK
| | - Claire Newton
- Gynaecology Oncology Department, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Shibani Nicum
- Department of Oncology, University College London Cancer Institute, London, UK
| | | | - Neil Ryan
- The Centre for Reproductive Health, Institute for Regeneration and Repair (IRR), 4-5 Little France Drive, Edinburgh BioQuarter City, Edinburgh EH16 4UU, UK
| | - Sudha Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham and Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, UK
| | - Katherine Vroobel
- Department of Cellular Pathology, Royal Marsden Foundation NHS Trust, London SW3 6JJ, UK
| | - Axel Walther
- Bristol Cancer Institute, University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Jason Wong
- Department of Histopathology, East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Heath Road, Ipswich IP4 5PD, UK
| | - Jo Morrison
- University of Exeter, Exeter, UK; Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton TA1 5DA, UK.
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2
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Shiao JC, Shen X. Contemporary Role of Radiation Therapy in Testicular Cancer. Urol Clin North Am 2024; 51:395-405. [PMID: 38925742 DOI: 10.1016/j.ucl.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Testicular cancer is a rare but curable male malignancy. Seminoma represents the majority of germ cell tumors and is considered radiation sensitive. Radiation treatment plays a role in adjuvant therapy after orchiectomy of stage I, IIA, and IIB seminomas. Radiation dose de-escalation has been effective in preventing tumor recurrences while also limiting acute and long-term toxicities. However, long-term risks, including the prevailing concern of secondary malignancy risk, between adjuvant radiation and chemotherapy play a role in recommendations. Ongoing work continues to be performed to reduce radiation field and dose in combination with chemotherapy while still maintaining excellent outcomes.
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Affiliation(s)
- Jay C Shiao
- Department of Radiation Oncology, University of Kansas Cancer Center, 4001 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Center, 4001 Rainbow Boulevard, Kansas City, KS 66160, USA
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3
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Chavarriaga J, Bobrowski A, Hamilton RJ. Guideline of guidelines: follow-up after orchidectomy for clinical stage 1 testicular cancer. BJU Int 2023; 132:485-495. [PMID: 37409830 DOI: 10.1111/bju.16111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Several medical organisations have developed evidence-based guidelines for the diagnosis, management, and follow-up of testicular cancer. This article aimed to review, compare, and summarise the most updated international guidelines and surveillance protocols for clinical stage 1 (CS1) testicular cancer. We reviewed a total of 46 articles on proposed follow-up strategies for testicular cancer, and six clinical practice guidelines including four guidelines published by urological scientific associations and two guidelines published by medical oncology associations. Most of these guidelines have been developed by panels of experts with different backgrounds in clinical training, and geographic practise patterns, which explains the considerable variability between published schedules, and recommended follow-up intensity. We present you with a comprehensive review of the most important clinical practice guidelines and propose unifying recommendations based on the most up to date evidence to help standardise follow-up schedules based on patterns and risk of disease relapse.
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Affiliation(s)
- Julian Chavarriaga
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Adam Bobrowski
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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4
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Da Silva A, Fléchon A, Coquan E, Planchamp F, Culine S, Murez T, Méjean A, Pasquier D, Chevreau C, Fizazi K, Thiery-Vuilemin A, Joly F. How to improve adherence of guidelines for localized testicular cancer surveillance: A Delphi consensus study. Front Oncol 2022; 12:1036190. [PMID: 36324582 PMCID: PMC9619048 DOI: 10.3389/fonc.2022.1036190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
Stage-I testicular germ-cell tumor (TGCT) has excellent cure rates. Surveillance is fully included in patient's management, particularly during the first years of follow-up. Surveillance guidelines differ between the academic societies, mainly concerning imaging frequency and long-term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. First, an online survey on surveillance practice of stage-I TGCT based on clinical-cases was conducted among urologists, radiation-oncologists and medical-oncologists. These results were compared to ESMO/EAU and AFU guidelines. Then a panel of experts assessed surveillance proposals following a Delphi-CM. Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. The study was conducted between July 2018 and May 2019. Concerning the first step: 61 participated to the survey (69% medical-oncologists, 15% urologists, 16% radiation-oncologists). About 65% of practitioners followed clinico-biological guidelines concerning 1 to 5 years of follow-up, but only 25% stopped surveillance after the 5th-year. No physician followed the EAU/ESMO guidelines of de-escalation chest imaging. Concerning the second step: 32 experts (78% medical-oncologists, 16% urologists, 6% radiation-oncologists) participated to the Delphi-CM. Thanks to Delphi-CM, a consensus was reached for 26 of the 38 statements. Experts agreed on clinico-biological surveillance modalities and end of surveillance after the 5th-year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th-year of follow-up. No consensus was reached regarding de-escalation of chest imaging. To conclude, the survey proved that French TGCT-specialists do not follow current guidelines. With Delphi-CM, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th-year, stop of AP scan on the 4th-year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.
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Affiliation(s)
| | - Aude Fléchon
- Centre Léon Bérard, Department of Medical Oncology, Lyon, France
| | - Elodie Coquan
- Centre François-Baclesse, Department of Medical Oncology, Caen, France
- Centre François-Baclesse, Clinical Research Unit, Caen, France
| | | | - Stéphane Culine
- Hôpital Saint-Louis, Department of Medical Oncology, Paris, France
| | - Thibaut Murez
- Hôpital Lapeyronie, Department of Urology, Montpellier, France
| | - Arnaud Méjean
- Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Department of Urology, Paris, France
| | - David Pasquier
- Centre Oscar Lambret, Department of Radiation Oncology, Lille, France
| | | | - Karim Fizazi
- Gustave Roussy, University of Paris Sud, Department of Medical Oncology, Villejuif, France
| | | | - Florence Joly
- Centre François-Baclesse, Department of Medical Oncology, Caen, France
- Centre François-Baclesse, Clinical Research Unit, Caen, France
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5
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Kaufmann E, Antonelli L, Albers P, Cary C, Gillessen Sommer S, Heidenreich A, Oing C, Oldenburg J, Pierorazio PM, Stephenson AJ, Fankhauser CD. Oncological Follow-up Strategies for Testicular Germ Cell Tumours: A Narrative Review. EUR UROL SUPPL 2022; 44:142-149. [PMID: 36106144 PMCID: PMC9465095 DOI: 10.1016/j.euros.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Luca Antonelli
- Department of Urology, Luzerner Kantonssspital, Lucerne, Switzerland
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Silke Gillessen Sommer
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biosciences, USI University, Lugano, Switzerland
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Christoph Oing
- Sir Bobby Robson Cancer Trials Research Centre, Department of Cancer Services, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway
| | - Phillip Martin Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christian Daniel Fankhauser
- University of Zurich, Zurich, Switzerland
- Department of Urology, Luzerner Kantonssspital, Lucerne, Switzerland
- Corresponding author. Department of Urology, Luzerner Kantonsspital, Spitalstrasse 6000, 16 Lucerne, Switzerland.
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6
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Schieda N, Oto A, Allen BC, Akin O, Barker SJ, Fulgham PF, Gettle LM, Maranchie JK, Patel BN, Schuster DM, Smith D, Turkbey IB, Lockhart ME. ACR Appropriateness Criteria® Staging and Surveillance of Testicular Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S194-S207. [PMID: 35550802 DOI: 10.1016/j.jacr.2022.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023]
Abstract
The staging and surveillance of testicular cancer is a complex topic, which integrates clinical, biochemical, and imaging components. The use of imaging for staging and surveillance of testicular cancer is individually tailored to each patient by considering tumor histology and prognosis. This document discusses the rationale for use of imaging by imaging modality during the initial staging of testicular seminoma and nonseminoma tumors and during the planned surveillance of stage IA and IB testicular cancer by histological subtype integrating clinical suspicion for disease recurrence in surveillance protocols. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Nicola Schieda
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada.
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York; Director of Body MRI
| | - Samantha J Barker
- University of Minnesota, Minneapolis, Minnesota; Director of Body Ultrasound M Health Fairview
| | - Pat F Fulgham
- Urology Clinics of North Texas, Dallas, Texas; American Urological Association; Chairman of the Department of Urology, Texas Health Presbyterian Hospital of Dallas
| | | | | | - Bhavik N Patel
- Stanford University Medical Center, Stanford, California; Director of AI
| | | | - Dan Smith
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada, Primary care physician
| | - Ismail B Turkbey
- National Institutes of Health, Bethesda, Maryland; Staff Clinician at NIH
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama; Chair, ACR Appropriateness Committee
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7
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Kjelle E, Andersen ER, Krokeide AM, Soril LJJ, van Bodegom-Vos L, Clement FM, Hofmann BM. Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review. BMC Med Imaging 2022; 22:73. [PMID: 35448987 PMCID: PMC9022417 DOI: 10.1186/s12880-022-00798-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate and wasteful use of health care resources is a common problem, constituting 10-34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging-in which the diagnostic test confers little to no clinical benefit-is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. METHODS A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. RESULTS A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. CONCLUSIONS A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020208072.
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Affiliation(s)
- Elin Kjelle
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Arne Magnus Krokeide
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
| | - Lesley J J Soril
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Leti van Bodegom-Vos
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fiona M Clement
- Department of Community Health Sciences and The Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bjørn Morten Hofmann
- Institute for the Health Sciences, The Norwegian University of Science and Technology (NTNU) at Gjøvik, NTNU Gjøvik, Postbox 191, 2802, Gjøvik, Norway
- Centre of Medical Ethics, The University of Oslo, Blindern, Postbox 1130, 0318, Oslo, Norway
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Dieckmann KP, Ruf CG, Gübitz R, Wülfing C, Zengerling F. [Follow-up of testicular germ cell tumors-historical aspects and current recommendations]. Urologe A 2022; 61:484-494. [PMID: 35384479 DOI: 10.1007/s00120-022-01815-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
Systematic follow-up examinations of patients cured of testicular cancer first gained attention by caregivers in the 1980s only after the management of the disease had significantly been improved by the introduction of cisplatin-based chemotherapy and almost synchronously, by the implementation of computerized tomography (CT) and serum tumor markers. Follow-up involves three aims: early diagnosis of recurrence, detection of treatment-related toxicity, and detection of secondary diseases. As the clinical presentation of testicular cancer is very heterogeneous, there is no uniform follow-up for the disease. Instead, risk-adapted follow-up schedules are required. Since the release of the German AWMF S3 guideline for the management of testicular cancer in 2019, high level evidence has accumulated for the noninferiority of magnetic resonance imaging (MRI) to CT with regard to abdominal imaging. Therefore, it is appropriate to modify the recommendations for follow-up given in the 2019 issue of the S3 guidelines. The modifications recommended herein relate to three issues: (1) Only three risk groups (instead of formerly four) are identified, i.e., seminoma (all stages); nonseminoma clinical stage 1b (i.e., pT2, with lymphovascular invasion) on surveillance; nonseminoma all other stages. All patients cured from poor risk disease or from relapses require individual follow-up schedules not included in the recommendations tabulated herein. (2) CT and abdominal sonography are replaced by MRI. (3) Chest X‑ray imaging during follow-up of seminoma patients is no longer recommended.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland.
| | | | - Raphael Gübitz
- Institut für Radiologie und Neuroradiologie, Asklepios Klinik Altona, Hamburg, Deutschland
| | - Christian Wülfing
- Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Straße 1, 22763, Hamburg, Deutschland
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9
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Busch J, Schmidt S, Albers P, Heinzelbecker J, Kliesch S, Lackner J, Pfister D, Ruf C, Winter C, Zengerling F, Beyersdorff D. Can magnetic resonance imaging replace conventional computerized tomography for follow-up of patients with testicular cancer? A systematic review. World J Urol 2022; 40:2843-2852. [PMID: 35037965 PMCID: PMC9712293 DOI: 10.1007/s00345-022-03931-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/05/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Follow-up protocols for patients with testicular cancer (TC) have significantly reduced the number of cross-sectional imaging studies to reduce radiation exposure. At present, it is unclear whether magnetic resonance imaging (MRI) could replace conventional computerized tomography (CT) imaging. The objective of this study is to summarize the scientific evidence on this topic and to review guideline recommendations with regard to the use of MRI. METHODS A systematic literature review was performed searching Medline and Cochrane databases for prospective studies on patients with TC in the follow-up care (last search in February 2021). Additionally, guideline recommendations for TC were screened. Data extraction and quality assessment of included studies were performed and used for a descriptive presentation of results. RESULTS A total of four studies including two ongoing trials were identified. Overall, the scientific evidence of prospective comparative studies is based on 102 patients. Data suggest that abdominal imaging with MRI can replace conventional CT for detection of lymph node metastasis of the retroperitoneum to spare radiation exposure and contrast media application. However, experienced radiologists are needed. Clinical guidelines are aware of the risk of diagnosis-induced secondary malignancy due to CT imaging and some have adapted their recommendations accordingly. Results of the two ongoing trials on 738 patients are expected soon to provide more reliable results on this topic. CONCLUSIONS There is growing evidence that abdominopelvic MRI imaging can replace CT imaging during follow-up of patients with TC in order to reduce radiation exposure and diagnosis-induced secondary malignancy.
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Affiliation(s)
- Jonas Busch
- grid.6363.00000 0001 2218 4662Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany ,grid.433867.d0000 0004 0476 8412Department of Urology, Vivantes Klinikum Am Urban, Dieffenbachstr. 1, 10967 Berlin, Germany
| | | | - Peter Albers
- grid.14778.3d0000 0000 8922 7789Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Julia Heinzelbecker
- grid.411937.9Department of Urology and Paediatric Urology, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Saar Germany
| | - Sabine Kliesch
- grid.16149.3b0000 0004 0551 4246Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital, Münster, Münster, Germany
| | - Julia Lackner
- UroEvidence@Deutsche Gesellschaft Für Urologie, Berlin, Germany
| | - David Pfister
- grid.411097.a0000 0000 8852 305XDepartment of Urology, University Hospital Cologne, Cologne, Germany
| | - Christian Ruf
- Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany
| | | | - Friedemann Zengerling
- grid.410712.10000 0004 0473 882XDepartment of Urology, University Hospital Ulm, Ulm, Germany
| | - Dirk Beyersdorff
- grid.13648.380000 0001 2180 3484Clinic and Polyclinic for Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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10
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Recent Progress in Technetium-99m-Labeled Nanoparticles for Molecular Imaging and Cancer Therapy. NANOMATERIALS 2021; 11:nano11113022. [PMID: 34835786 PMCID: PMC8618883 DOI: 10.3390/nano11113022] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 12/12/2022]
Abstract
Nanotechnology has played a tremendous role in molecular imaging and cancer therapy. Over the last decade, scientists have worked exceptionally to translate nanomedicine into clinical practice. However, although several nanoparticle-based drugs are now clinically available, there is still a vast difference between preclinical products and clinically approved drugs. An efficient translation of preclinical results to clinical settings requires several critical studies, including a detailed, highly sensitive, pharmacokinetics and biodistribution study, and selective and efficient drug delivery to the target organ or tissue. In this context, technetium-99m (99mTc)-based radiolabeling of nanoparticles allows easy, economical, non-invasive, and whole-body in vivo tracking by the sensitive clinical imaging technique single-photon emission computed tomography (SPECT). Hence, a critical analysis of the radiolabeling strategies of potential drug delivery and therapeutic systems used to monitor results and therapeutic outcomes at the preclinical and clinical levels remains indispensable to provide maximum benefit to the patient. This review discusses up-to-date 99mTc radiolabeling strategies of a variety of important inorganic and organic nanoparticles and their application to preclinical imaging studies.
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11
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Rizzo M, Ongaro L, Claps F, Ghassempour D, Verzotti E, Migliozzi F, Boltri M, Pavan N, Garaffa G, Bucci S, Umari P, Trombetta C, Liguori G. Analysis of clinical utility of abdominopelvic computed tomography in the follow-up of Stage I seminoma: a single center evaluation. Minerva Urol Nephrol 2021; 73:84-89. [PMID: 31833335 DOI: 10.23736/s2724-6051.19.03562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma. METHODS The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging. RESULTS Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.
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Affiliation(s)
- Michele Rizzo
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy -
| | - Luca Ongaro
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Dario Ghassempour
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Enrica Verzotti
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesca Migliozzi
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Stefano Bucci
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Paolo Umari
- Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy
| | - Carlo Trombetta
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
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12
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Gilligan T, Lin DW, Aggarwal R, Chism D, Cost N, Derweesh IH, Emamekhoo H, Feldman DR, Geynisman DM, Hancock SL, LaGrange C, Levine EG, Longo T, Lowrance W, McGregor B, Monk P, Picus J, Pierorazio P, Rais-Bahrami S, Saylor P, Sircar K, Smith DC, Tzou K, Vaena D, Vaughn D, Yamoah K, Yamzon J, Johnson-Chilla A, Keller J, Pluchino LA. Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 17:1529-1554. [PMID: 31805523 DOI: 10.6004/jnccn.2019.0058] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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 nerve-sparing 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.
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Affiliation(s)
- Timothy Gilligan
- 1Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Daniel W Lin
- 2University of Washington/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | | | | | | | | | - Will Lowrance
- 14Huntsman Cancer Institute at the University of Utah
| | | | - Paul Monk
- 16The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Joel Picus
- 17Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | | | - Daniel Vaena
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - David Vaughn
- 25Abramson Cancer Center at the University of Pennsylvania
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13
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Orillard E, Klajer E, Kalbacher E, Joly F, David A, Hervé L, Viot J, Mouillet G, Barkatz J, Kleinclauss F, Thiery-Vuillemin A. [Relapse surveillance of patients with testicular germ cell tumor]. Bull Cancer 2019; 106:903-914. [PMID: 31495441 DOI: 10.1016/j.bulcan.2019.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Germ-cell tumors are the most common solid tumors in young men. The follow-up of these patients is very important in their management. In stage I testicular cancer, surveillance is the standard for low-risk disease. In addition to the early detection of relapse, follow-up should be directed towards prevention, detection and treatment of late toxicity, and secondary malignancies. Follow up consists in physical examination, laboratory analysis and radiological imaging. Recently, guidelines recommend risk-adapted surveillance strategy, with a reduction of CT scans numbers, due to the recognition of the risk of ionizing radiation exposure. However, efforts to maintain adequate compliance with follow up are required.
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Affiliation(s)
| | - Elodie Klajer
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | - Elsa Kalbacher
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | - Florence Joly
- Inserm, U1086, UNICANCER, centre François Baclesse, Clinical Research Department and Medical Department, 14076 Caen, France
| | - Alina David
- CHU de Besançon, radiologie, 25030 Besançon cedex, France
| | - Laure Hervé
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | - Julien Viot
- CHU de Besançon, oncologie, 25030 Besançon cedex, France
| | | | | | - François Kleinclauss
- Inserm, UMR1098, 25020 Besançon cedex, France; Université de Franche-Comté, UMR1098, SFR IBCT, 25020 Besançon, France; CHU de Besançon, urologie, 25030 Besançon cedex, France
| | - Antoine Thiery-Vuillemin
- CHU de Besançon, oncologie, 25030 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France; Université de Franche-Comté, UMR1098, SFR IBCT, 25020 Besançon, France
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14
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Thomas LJ, Brooks MA, Stephenson AJ. The Role of Imaging in the Diagnosis, Staging, Response to Treatment, and Surveillance of Patients with Germ Cell Tumors of the Testis. Urol Clin North Am 2019; 46:315-331. [DOI: 10.1016/j.ucl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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16
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Peña HDL. Stratified follow-up pathways for cancer patients. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3s-s80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Lehnich AT, Rusner C, Chodick G, Katz R, Sella T, Stang A. Actual frequency of imaging during follow-up of testicular cancer in Israel-a comparison with the guidelines. Eur Radiol 2019; 29:3918-3926. [PMID: 31016446 DOI: 10.1007/s00330-019-06148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Computed tomography (CT) examinations are frequent in follow-up care of testicular cancer (TC) but may increase the risk for other cancers. We wanted to assess the actual number of CT and X-ray examinations within the first 5 years after a diagnosis of TC in Israel during 2003-2007. METHODS The database of Maccabi Healthcare Services, Israel, was searched for TC patients diagnosed in 2003 to 2007 by direct linkage with the Israel National Cancer Registry. Data on diagnostic imaging examinations (CT of chest, abdomen, or pelvis, unspecified sites; X-ray of chest) were extracted during a 5-year follow-up for 226 incident patients. The actual number of CT and X-ray examinations was compared to the National Comprehensive Cancer Network (NCCN) guideline. We tabulated the median with 10th and 90th percentiles (P10, P90) for the number of CTs and X-rays considering histology, stage, and adjuvant strategy. RESULTS The number of abdomen or pelvis CTs for TC patients receiving chemo- or radiotherapy was in accordance with the NCCN guideline. The median of abdomen or pelvis CTs for surveillance patients was 8.5 (P10, P90: 3; 13) for nonseminoma and 5.0 (P10, P90: 5; 13) for seminoma patients compared to 14 to 17 CTs recommended. The number of chest X-rays was lower than recommended in the guideline for all adjuvant strategies. CONCLUSIONS The NCCN guidelines regarding CTs were met for TC patients treated with chemo- or radiotherapy but fell below recommendations for surveillance. Guidelines from 2011 and 2012 were updated in favor of fewer CTs during surveillance. KEY POINTS • The number of CTs followed the NCCN guidelines in patients treated with chemo- or radiotherapy. • Surveillance patients received fewer CTs and X-rays than recommended in the NCCN guidelines from 2005. • The number of applied CT examinations corresponded to a radiation dose that did not substantially raise the lifetime risk for cancer.
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Affiliation(s)
- Anna-Therese Lehnich
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Carsten Rusner
- Radiology Office, Hospital St. Elisabeth and St. Barbara, Mauerstraße 5, 06110, Halle, Germany
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Ramat Aviv, 69978, Tel Aviv, Israel
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
| | - Rachel Katz
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
| | - Tal Sella
- Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel
- Department of Medical Oncology, Dana-Faber Cancer Institute, 450 Brookline Ave, Boston, MA, USA
| | - Andreas Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
- School of Public Health, Department of Epidemiology, Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
- German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany
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Cost Analysis of Noninvasive Blood-Based MicroRNA Testing Versus CT Scans for Follow-up in Patients With Testicular Germ-Cell Tumors. Clin Genitourin Cancer 2019; 17:e733-e744. [PMID: 31155478 DOI: 10.1016/j.clgc.2019.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Our group has developed a noninvasive blood-based microRNA (miRNA) test for improving diagnosis, disease monitoring, and relapse detection in malignant testicular germ-cell tumors (TGCTs). Performance analysis suggests the test is likely to have comparable sensitivity and specificity in detecting TGCT as computed tomography (CT), thus reducing the need for serial CT scans for follow-up monitoring, with associated reductions in cumulative radiation burden and second cancer risk. To facilitate clinical adoption, we undertook a cost analysis to identify the budget impact of replacing CT scans with miRNA testing within health care systems. METHODS The TGCT aftercare pathway was mapped out using National Comprehensive Cancer Network guidelines. A Markov model was built to simulate the impact of the miRNA test on TGCT aftercare costs. Incidence, treatment probabilities, relapse rate, and death rate data were collected from published studies to populate the model. RESULTS Applying our model to the US health care system, the miRNA test has the potential to save up to $69 million per year in aftercare expenses related to TGCT treatment, with exact savings depending on the adoption rate and test price. CONCLUSION This analysis demonstrates the potential positive budget impact of adopting miRNA testing in place of CT scans in the clinical management of TGCTs.
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The diagnostic performance of current tumour markers in surveillance for recurrent testicular cancer: A diagnostic test accuracy systematic review. Cancer Epidemiol 2019; 59:15-21. [PMID: 30658216 DOI: 10.1016/j.canep.2019.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/21/2018] [Accepted: 01/01/2019] [Indexed: 11/20/2022]
Abstract
In this diagnostic test accuracy systematic review we summarise the evidence on the diagnostic accuracy of blood α-fetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) in surveillance for testicular cancer recurrence in adults. We searched four electronic databases for studies that reported the diagnostic accuracy of HCG, AFP, and/or LDH in sufficient detail for sensitivity and specificity to be calculated by extracting a 2 × 2 table comparing biomarker positivity with testicular cancer recurrence. Screening, data extraction and QUADAS-2 quality assessment were completed by two independent reviewers. From 2406 studies, nine met our inclusion criteria. Eight reported data at the per-patient level. Sample sizes were small (range 5 to 449 patients) and clinical heterogeneity precluded meta-analysis. In most studies the specificity for recurrence with AFP and HCG was high (90-100%) but sensitivity was often relatively low, suggesting that many recurrences would not be detected by tumour markers alone. The diagnostic performance of LDH appears poorer. Studies were methodologically weak, with probable selection, incorporation and partial verification bias, and many studies were excluded for not reporting on recurrence-free patients. Limitations including small sample sizes, high heterogeneity, and inconsistent and incomplete reporting mean these results must be interpreted with caution. Despite inclusion of biomarkers in international surveillance guidance, there remains a lack of high quality evidence about their accuracy, optimal thresholds, and the most effective surveillance strategy in relation to contemporary investigative modalities. Higher quality research using data from modern-day follow-up cohorts is necessary to identify opportunities to reduce unnecessary testing.
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20
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Follow-Up for Testicular Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Ruf CG. Follow-Up for Testicular Cancer. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_11-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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22
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Milic M, Hall M, Hawkins A, Gogbashian A, Rustin G, Sharma A. A Qualitative Analysis of the Impact of Carboplatin AUC 10 on Physical, Work Functioning and Bone Marrow Toxicity Among Seminoma Patients - A Single-centre Experience. In Vivo 2018; 33:233-237. [PMID: 30587629 DOI: 10.21873/invivo.11465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Single-agent carboplatin at area under the curve 10 (AUC10) is an effective treatment for metastatic seminoma. As far as we are aware of, there have been no studies reporting its effects on short-term quality of life. The objective was to study the efficacy, safety and tolerability, using health-related quality of life, of carboplatin AUC10 chemotherapy in patients with metastatic seminoma. PATIENTS AND METHODS Forty-four patients with metastatic seminoma treated at Mount Vernon Cancer Centre with carboplatin AUC10 were included in this study. Response to treatment was determined by radiological imaging (Response Evaluation Criteria in Solid Tumors v 1.1) and serum tumour markers. Toxicities were evaluated using the Common Terminology Criteria for Adverse Events Version 4.0. Quality of life treatment-related toxicities were assessed during treatment at pre-chemotherapy assessments. After treatment, toxicity was assessed using a defined telephone questionnaire consisting of four questions relating to hair loss, hearing impairment, days absent from work, and neuropathy. RESULTS At a median follow-up of 27.5 (range=4-84) months, no patient had experienced relapse. Grade 3/4 neutropenia was seen in 15 (35%) patients, nine (21%) required prophylactic granulocyte colony-stimulating factor, 13 (30%) patients had grade 3/4 thrombocytopenia. Commonest non-haematological toxicities were fatigue in 28 (65%) and nausea 14 (33%) patients. They were grade 1 in 82% and 92% of cases, respectively. Six out of 44 (14%) had residual tinnitus. One patient had residual grade 1 peripheral neuropathy. Ten patients continued to work throughout treatment and two patients were retired. Of the remaining patients, 16 (37%), took fewer than 5 days off work. CONCLUSION Carboplatin AUC10 is a safe and effective treatment for stage II/III seminoma with better health-related quality of life than experienced with combination cisplatin-based chemotherapy.
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Affiliation(s)
- Marina Milic
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Annette Hawkins
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Andrew Gogbashian
- Department of Radiology, Mount Vernon Cancer Centre, Paul Strickland Scanner Centre, Northwood, U.K
| | - Gordon Rustin
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, U.K.
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Hamilton RJ. Active Surveillance for Stage I Testicular Cancer: A Four-decade–old Experiment Proven Correct. Eur Urol 2018; 73:908-909. [DOI: 10.1016/j.eururo.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
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