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Rosen DB, Ghosh A, Niemierko A, Beard CJ, Ravi P, Tewari A, Sweeney C, Lee RJ, Saylor P, Martin N, Efstathiou JA, Mouw K, Kamran SC. Clinical Outcomes of De Novo Versus Relapsed Early Metastatic Testicular Seminoma Treated With Contemporary Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:706-711. [PMID: 37717783 DOI: 10.1016/j.ijrobp.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Chemotherapy (CHT) or radiation therapy (RT) are first-line treatments for clinical stage II (CS-II) testicular seminoma. Historically, clinical stage I (CS-I) seminoma was also treated with CHT or RT, but in the past 2 decades practice has shifted toward active surveillance for CS-I with RT or CHT reserved for patients with progression to CS-II. Limited data exist on contemporary RT techniques and patient stratification (ie, de novo [CS-II at orchiectomy] vs relapsed [CS-II diagnosed during surveillance after orchiectomy for CS-I]). We investigated outcomes in CS-II patients treated with RT in the modern era across 2 institutions. METHODS AND MATERIALS A retrospective review identified 73 patients treated with RT for CS-II A or B seminoma between 2001 and 2022. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and univariate analyses were performed with log-rank or Cox proportional hazard regression. Recurrence was defined as biopsy-proven metastatic seminoma after RT completion. Second malignancies were defined as a biopsy-proven malignancy originating in the prior RT field. RESULTS Thirty-eight (52%) patients presented with de novo CS-II and 35 (48%) patients had relapsed CS-II. Median follow-up was 4.8 years (IQR: 2.3-8.1). Five-year RFS was 82% overall (92% in relapsed patients and 73% in de novo patients). Relapsed CS-II disease had lower recurrence rates after RT compared with de novo CS-II disease. All recurrences occurred outside the prior RT field and were salvaged. Disease-specific survival was 100%. Two second malignancies occurred (prostate, colorectal cancer at 67 months and 119 months post-RT, respectively). CONCLUSIONS In patients with CS-II seminoma treated with modern RT, there were no in-field recurrences. Presentation with de novo CS-II is associated with out-of-field recurrence. Subject to further larger-scale validation, our results suggest that compared with CS-II at time of relapse, de novo CS-II may portend more aggressive or micrometastatic disease beyond the retroperitoneum, raising the possibility of benefit from CHT after radiation.
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Affiliation(s)
- Daniel B Rosen
- Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Clair J Beard
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Praful Ravi
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alok Tewari
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Christopher Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Richard J Lee
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Philip Saylor
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Neil Martin
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kent Mouw
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.
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Rosen DB, Tan AJN, Pursley J, Kamran SC. Advances in radiation therapy for testicular seminoma. World J Urol 2023; 41:3895-3903. [PMID: 37979002 DOI: 10.1007/s00345-023-04674-8] [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] [Received: 08/03/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Novel techniques and advances in radiation therapy (RT) have been explored to treat testicular seminoma, a highly radiosensitive and curable histology. We evaluated the historical and current indications for radiation therapy (RT) in testicular seminoma. METHODS A narrative literature review was performed. Studies of RT for testicular seminoma were included. Additionally, recent trials testing the use of combination or surgical therapies for clinical stage (CS) II were included. Search parameters included radiation therapy, testicular seminoma, surgery, and chemoradiation. Parameters and outcomes assessed were progression-free survival (PFS), overall survival (OS), acute toxicities, long-term sequelae, and rates of secondary malignancies. RESULTS Practice defining and changing studies in the use or omission of radiation therapy for testicular seminoma were identified along with resultant changes in National Comprehensive Cancer Network (NCCN) and European guidelines. Recent trials in combined chemoradiation and upfront surgical approaches to CS II disease were reviewed. CONCLUSION RT has historically been used as adjuvant treatment for CS I disease and is highly effective at treating CS II (A/B) testicular seminoma. The drive to maintain therapeutic efficacy and reduce acute and long-term side effects, namely secondary malignancies, is being tested using new radiation technologies, combined modality therapy in the form of chemoradiation and with upfront surgical approaches. Also, as guidelines now "strongly prefer" surveillance instead of adjuvant RT for CS I disease, the current CS II population comprises patients presenting with CS II disease ("de novo") and those who present with CSII after relapsing post orchiectomy for CS I ("relapsed"). Emerging evidence suggests that these two groups have different outcomes with respect to RT and chemoradiation. Consequently, future trials may need to sub-stratify according to these groups.
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Affiliation(s)
| | - Arvin Jeremy N Tan
- Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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3
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Alsyouf M, Nappi L, Nichols C, Daneshmand S. Plasma Micro-RNA 371 Expression in Early-Stage Germ Cell Tumors: Are We Ready to Move Toward Biology-Based Decision Making? J Clin Oncol 2023; 41:2478-2482. [PMID: 36758194 DOI: 10.1200/jco.22.02002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- Muhannad Alsyouf
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Lucia Nappi
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Craig Nichols
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
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Therapy of clinical stage IIA and IIB seminoma: a systematic review. World J Urol 2022; 40:2829-2841. [PMID: 34779882 PMCID: PMC9712301 DOI: 10.1007/s00345-021-03873-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options. METHODS A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed. RESULTS Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%-21.1% for RT and of 0%-14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities. CONCLUSIONS RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation.
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Alsyouf M, Daneshmand S. Clinical stage II seminoma: management options. World J Urol 2021; 40:343-348. [PMID: 34655305 DOI: 10.1007/s00345-021-03854-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The management of clinical stage II seminoma has evolved with a recent emphasis on minimizing long-term morbidity while achieving oncologic cure. METHODS In this review we discuss the available management options for clinical stage II seminoma with an emphasis on the emerging role of surgery in this patient population. RESULTS Historically, treatment options available to clinical stage II seminoma patients were limited to radiotherapy and chemotherapy. Survival rates with these options are excellent; however, both are associated with significant long-term morbidities including cardiovascular, pulmonary, and neurologic toxicities. Additionally, higher rates of secondary malignancies are witnessed in this young patient population, decades after successful treatment of the primary cancer. Recently, retroperitoneal lymph node dissection has been proposed as a first-line treatment option for patients with low-volume metastatic seminoma. CONCLUSION The SEMS and PRIMETEST trials are two studies examining the role of primary retroperitoneal lymph node dissection in clinical stage II seminoma, and early data show significant promise.
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Affiliation(s)
- Muhannad Alsyouf
- USC Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., suite 7416, Los Angeles, CA, 90089, USA
| | - Siamak Daneshmand
- USC Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., suite 7416, Los Angeles, CA, 90089, USA.
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Dotzauer R, Salamat A, Nabar ND, Thomas A, Böhm K, Brandt MP, Mager R, Borgmann H, Kurosch M, Hoefner T, Tsaur I, Hötker AM, Haferkamp A, Jäger W. The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making. Minerva Urol Nephrol 2021; 74:72-76. [PMID: 33439568 DOI: 10.23736/s2724-6051.20.03877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI-abdomen. It has not been investigated so far whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial staging and occurrence of unspecific lymph node enlargement and adjuvant therapies after inguinal orchiectomy. METHODS We retrospectively evaluated clinical and radiological data from 236 patients who had undergone inguinal orchiectomy for testicular cancer at our department. Statistical analysis was performed to determine whether the occurrence of unspecific lymph node enlargement or the rate of adjuvant therapies were influenced by timing of initial staging (preoperative vs. postoperative). RESULTS The postoperative imaging cohort showed significant more inguinal, pelvic and retroperitoneal unspecific lymph node enlargement than the preoperative imaging cohort. Simultaneous occurrence of inguinal or pelvic lymph node enlargement together with retroperitoneal enlargements could only be found in the postoperative imaging cohort. No difference regarding adjuvant therapies could be found. CONCLUSIONS Timing of imaging affects the detection rate of unspecific lymph node enlargements but does not show a significant effect on the rate of adjuvant therapies.
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Affiliation(s)
- Robert Dotzauer
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany -
| | - Arash Salamat
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Nikita D Nabar
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Anita Thomas
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Böhm
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Maximilian P Brandt
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - René Mager
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Martin Kurosch
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Hoefner
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Andreas M Hötker
- Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Rämigstrasse, Switzerland
| | - Axel Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Aydin AM, Zemp L, Cheriyan SK, Sexton WJ, Johnstone PAS. Contemporary management of early stage testicular seminoma. Transl Androl Urol 2020; 9:S36-S44. [PMID: 32055484 PMCID: PMC6995845 DOI: 10.21037/tau.2019.09.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022] Open
Abstract
Therapy for early stage testicular seminoma has changed radically over the past several decades. Given high cure rates and clinical trials supporting less active therapy in most cases, close observation after radical orchiectomy is now considered standard of care for clinical stage (CS) IA/IB seminoma, with either radiation therapy (RT) or chemotherapy salvage options possible. For CS IIA/IIB seminoma characterized by non-bulky retroperitoneal lymph node involvement (≤5 cm in greatest dimension), RT or combination chemotherapy are the standard of care. Given high comparable survival rates, preventing treatment-related toxicity and second malignancy, and limiting quality of life deficits associated with intense treatment has gained much greater importance. Clinical trials are currently testing the feasibility of retroperitoneal lymph node dissection (RPLND) for low volume CS IIA/IIB metastatic testicular seminoma to this end. Likewise, one cycle of chemotherapy is being evaluated as an adjuvant approach to reduce recurrence rates in CS I disease with unfavorable risk factors. Moreover, recent genomic and molecular studies have recently identified novel signatures and a potential biomarker for testicular seminoma. In this review, we first summarize the evolution of early stage seminoma management and discuss the effectiveness and drawbacks of contemporary treatment strategies. We further outline future perspectives and potential challenges in management of early stage testicular seminoma.
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Affiliation(s)
- Ahmet Murat Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Salim K. Cheriyan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter A. S. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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8
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Lavaud P, Baciarello G, Fizazi K. [Management of metastatic testicular germ cell tumors]. Bull Cancer 2019; 106:896-902. [PMID: 31466695 DOI: 10.1016/j.bulcan.2019.05.004] [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: 12/02/2018] [Revised: 05/01/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
Metastatic testicular germ cell tumors are rare entities with a high cure rate owing to their major chemosensitivity. Current guidelines should be strictly followed to ensure maximal cure rate. Germ cell tumor treatment requires multidisciplinary skills and is based on cisplatin-based chemotherapy. The current challenge for these patients with favorable prognosis is to limit over- or under-treatment. Centralization of care for patients with these rare cancers is a key point to achieve the best chance of cure.
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Affiliation(s)
- Pernelle Lavaud
- Université Paris-Saclay, Gustave-Roussy, Department of Cancer Medicine, 114, rue Edouard-Vaillant, Villejuif, France.
| | - Giulia Baciarello
- Université Paris-Saclay, Gustave-Roussy, Department of Cancer Medicine, 114, rue Edouard-Vaillant, Villejuif, France
| | - Karim Fizazi
- Université Paris-Saclay, Gustave-Roussy, Department of Cancer Medicine, 114, rue Edouard-Vaillant, Villejuif, France
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Casadei C, Schepisi G, Menna C, Chovanec M, Gurioli G, Gallà V, Altavilla A, Marcellini M, Bellia SR, Lolli C, Mego M, Rosti G, De Giorgi U. Reclassification of good-risk seminoma: prognostic factors, novel biomarkers and implications for clinical management. Future Oncol 2019; 15:1347-1352. [DOI: 10.2217/fon-2018-0850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Germ cell tumors represent 11% of the cancers diagnosed in adolescent males and are the most common solid tumors in adult men between the ages of 20 and 35. Pure seminoma accounts for around 50% of all testicular germ cell tumors. The prognostic classification of the International Germ Cell Cancer Collaborative Group for good-prognosis seminoma includes both nodal disease and pulmonary visceral metastases. In this article, we analyzed recent data on prognosis and outcome of good-prognosis seminoma to revise the traditional classification of the disease and improve tailored treatment.
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Affiliation(s)
- Chiara Casadei
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giuseppe Schepisi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Cecilia Menna
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michal Chovanec
- Second Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Giorgia Gurioli
- Biosciences Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Valentina Gallà
- Unit of Biostatistics & Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Amelia Altavilla
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Salvatore Roberto Bellia
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Cristian Lolli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Michal Mego
- Second Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Giovanni Rosti
- Department of Oncology, Policlinico San Matteo IRCCS, Pavia, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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10
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Lieng H, Warde P, Bedard P, Hamilton RJ, Hansen AR, Jewett MAS, O'malley M, Sweet J, Chung P. Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach. Can Urol Assoc J 2017; 12:59-66. [PMID: 29381453 DOI: 10.5489/cuaj.4531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Testicular seminoma most commonly affects young men and is associated with favourable prognosis. Various followup schedules and imaging protocols for testicular seminoma have been described without overall consensus. We reviewed the literature together with our experience at the Princess Margaret Cancer Centre and present an evidence-based followup approach for patients with stage I and II seminoma.
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Affiliation(s)
- Hester Lieng
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
| | - Philippe Bedard
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto; Toronto, ON, Canada
| | - Robert J Hamilton
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology & Hematology, Princess Margaret Cancer Centre, University Health Network and Department of Medicine, University of Toronto; Toronto, ON, Canada
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Martin O'malley
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University of Toronto; Toronto, ON, Canada
| | - Joan Sweet
- Department of Pathology and Lab Medicine, University Health Network, University of Toronto; Toronto, ON, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and Department of Radiation Oncology, University of Toronto; Toronto, ON, Canada
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11
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Physical long-term side-effects in young adult cancer survivors: germ cell tumors model. Curr Opin Oncol 2017; 29:229-234. [PMID: 28463858 DOI: 10.1097/cco.0000000000000375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW After the important advances in the treatment of germ cell tumors (GCTs) leading to high cure rates, physical long-term side-effects represent an important cause of death in these young adult survivors. Highlighting these physical long-term side-effects, their monitoring and their prevention modalities is necessary for a better management of these cancer survivors. RECENT FINDINGS Impaired fertility, increased risk of developing a second cancer, cardiac, pulmonary, renal and neural toxicity, hearing and vision impairment are the major physical side-effects in young adult cancer survivors. Long-term cardiac toxicity, next to second malignancies, represents life-threatening conditions in testicular cancer survivors. The long-term nephrotoxity in testicular GCTs survivors is most frequently associated to the treatment either in those treated with cisplatin-based chemotherapy, mainly Bleomycine, Etoposide, Cisplatin, or those receiving infradiaphragmatic radiation therapy, whereas pulmonary toxicity is mainly attributed to bleomycin related toxicities. SUMMARY There are no clear and comprehensive data concerning the monitoring and prevention of long-term side-effects in testicular cancer survivors. Physical activity and interventions in modifiable cardiovascular risk factors and lifestyles may reduce the incidence of long-term side-effects in these cancer survivors.
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12
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Mortensen MS, Bandak M, Kier MGG, Lauritsen J, Agerbaek M, Holm NV, von der Maase H, Daugaard G. Surveillance versus adjuvant radiotherapy for patients with high-risk stage I seminoma. Cancer 2016; 123:1212-1218. [DOI: 10.1002/cncr.30458] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Mette S. Mortensen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mikkel Bandak
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Maria G. G. Kier
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
- Unit of Survivorship; Danish Cancer Society Research Center, Danish Cancer Society; Copenhagen Denmark
| | - Jakob Lauritsen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mads Agerbaek
- Department of Oncology; Aarhus University Hospital; Aarhus Denmark
| | - Niels V. Holm
- Department of Oncology; Odense University Hospital; Odense Denmark
| | - Hans von der Maase
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Gedske Daugaard
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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13
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Stage II Testicular Seminoma: Patterns of Care and Survival by Treatment Strategy. Clin Oncol (R Coll Radiol) 2016; 28:513-21. [DOI: 10.1016/j.clon.2016.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 01/06/2023]
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14
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Ahmed KA, Wilder RB. Stage IIA and IIB testicular seminoma treated postorchiectomy with radiation therapy versus other approaches: a population-based analysis of 241 patients. Int Braz J Urol 2015; 41:78-85. [PMID: 25928512 PMCID: PMC4752059 DOI: 10.1590/s1677-5538.ibju.2015.01.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 05/05/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate post-orchiectomy utilization of radiation therapy (RT) versus other management approaches in stage IIA and IIB testicular seminoma patients. Materials and Methods Two hundred and forty-one patients with stage IIA and IIB testicular seminoma were identified between 1988 and 2003 using the Surveillance, Epidemiology, and End Results (SEER) database. Results Median follow-up was 10 years. Patients with stage IIA disease underwent RT more frequently than those with stage IIB disease (72% vs. 46%, respectively; P<0.001). There was no significant change in RT utilization for stage IIA or IIB disease between 1988 and 2003 (P = 0.89). Conclusions Between 1988 and 2003, stage IIA patients underwent RT more often than stage IIB patients in the United States. There was no significant change in RT utilization for stage IIA or IIB disease during this time period. Based on reports describing excellent progression-free survival with cisplatin-based chemotherapy, this approach has increased in popularity since 2003 and may eventually become the most popular treatment approach for both stage IIA and IIB testicular seminoma.
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Affiliation(s)
- Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Richard B Wilder
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Giannatempo P, Greco T, Mariani L, Nicolai N, Tana S, Farè E, Raggi D, Piva L, Catanzaro M, Biasoni D, Torelli T, Stagni S, Avuzzi B, Maffezzini M, Landoni G, De Braud F, Gianni A, Sonpavde G, Salvioni R, Necchi A. Radiotherapy or chemotherapy for clinical stage IIA and IIB seminoma: a systematic review and meta-analysis of patient outcomes. Ann Oncol 2015; 26:657-668. [DOI: 10.1093/annonc/mdu447] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Hu B, Shah S, Shojaei S, Daneshmand S. Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma. Clin Genitourin Cancer 2015; 13:e265-e269. [PMID: 25682512 DOI: 10.1016/j.clgc.2015.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/04/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The long-term morbidity associated with treating advanced seminoma can be significant. Retroperitoneal lymph node dissection (RPLND) has established oncologic efficacy in treating germ cell tumors with minimal long-term toxicity. We describe our experience with RPLND as a front-line treatment of lymph node-positive seminoma. MATERIALS AND METHODS We reviewed our institutional review board-approved testicular cancer database to find the patients with pure seminoma and isolated retroperitoneal lymph node disease who had undergone primary RPLND. The clinical and pathologic variables were obtained. The follow-up data were used to determine recurrence and death. RESULTS Four patients with a mean age of 37 years were identified. All patients had normal tumor markers and retroperitoneal lymphadenopathy measuring 1.1, 1.5, 1.8, and 5.5 cm before RPLND. Of the 4 patients, 3 had had seminoma diagnosed at orchiectomy and 1 (with a 5.5-cm retroperitoneal lymphadenopathy and a burned out primary testicular mass) had had seminoma diagnosed at RPLND after 2 nondiagnostic retroperitoneal biopsies. All patients had undergone nerve-sparing, template, extraperitoneal RPLND and were discharged home after 3 days. An average of 3 positive lymph nodes were found. Of the 4 patients, 3 had pathologic stage IIA and 1 stage IIB disease, with no patient undergoing adjuvant therapy. At a mean follow-up period of 25 months, no patient had experienced disease recurrence, and none had died. All patients maintained antegrade ejaculation, and no long-term complications had developed. CONCLUSION Our small series has demonstrated encouraging oncologic efficacy for RPLND as a primary treatment of retroperitoneal lymph node-positive seminoma. A multi-institutional phase II trial of RPLND for stage IIA seminoma is being developed.
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Affiliation(s)
- Brian Hu
- Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Swar Shah
- Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Sepehr Shojaei
- Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Siamak Daneshmand
- Department of Urology, USC Institute of Urology, USC Norris Comprehensive Cancer Center, University of Southern California Keck School of Medicine, Los Angeles, CA.
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Stein ME, Zidan J, Charas T, Ben-Yosef R. Radiotherapy for Stage IIA seminoma: The Northern Israel Oncology Center Experience, 1971-2010. Rep Pract Oncol Radiother 2014; 19:281-6. [PMID: 25184051 PMCID: PMC4150093 DOI: 10.1016/j.rpor.2014.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 01/31/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022] Open
Abstract
AIM To evaluate treatment details, outcome, relapse rate and side-effects in Stage IIA seminoma irradiated and followed for a period of 39 years. BACKGROUND Seminoma is a very radiosensitive disease and radiation therapy alone is able to achieve long-term disease-free survival, even in advanced Stage disease. Due to the lack of long-term prospective studies, it is of value to follow patients and try to determine the appropriate volume to be irradiated and the dose which can achieve total cure with minimal acute and chronic side-effects. PATIENTS AND METHODS A retrospective review of 24 Stage IIA seminoma patients irradiated between 1971 and 2010 was performed. All patients underwent orchiectomy and meticulous clinical, biochemical and radiological staging. RESULTS Median age at diagnosis was 36 years and median follow-up was 84 months. A majority of patients received the "hockey-stick" irradiation schedule (para-aortic lymph nodes and hemi-pelvis) to a total dose of 2250-2500 cGy and a boost to radiologically involved nodes of 500-1000 cGy. Treatment was well-tolerated. Twenty-one (88%) patients are alive with no evidence of disease. Two patients died due to unknown causes, while one patient died due to head of the pancreas carcinoma, most probably radiation-induced. CONCLUSIONS In Stage II seminoma, radiotherapy can provide excellent results with low rates of toxicity. Reduction of total dose and size of fields without affecting the good results should be considered. Due to prolonged survival, awareness of second primary tumor is indicated.
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Affiliation(s)
- Moshe E. Stein
- The Northern Israel Oncology Center, Rambam Health Care Campus and Faculty of Medicine, Haifa, Israel
| | - Jamal Zidan
- Department of Oncology, Safed Medical Center, Safed, and Israel Faculty of Medicine in the Galilee, Bar-Ilan University, Israel
| | - Tomer Charas
- The Northern Israel Oncology Center, Rambam Health Care Campus and Faculty of Medicine, Haifa, Israel
| | - Rahamim Ben-Yosef
- The Northern Israel Oncology Center, Rambam Health Care Campus and Faculty of Medicine, Haifa, Israel
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Quiñonez MAL. Uso de la quimioterapia en cáncer testicular de células germinales. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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