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Nestler T, Schoch J, Belge G, Dieckmann KP. MicroRNA-371a-3p-The Novel Serum Biomarker in Testicular Germ Cell Tumors. Cancers (Basel) 2023; 15:3944. [PMID: 37568759 PMCID: PMC10417034 DOI: 10.3390/cancers15153944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Testicular germ cell tumors (TGCTs) are a paradigm for the use of serum tumor markers in clinical management. However, conventional markers such as alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH) have quite limited sensitivities and specificities. Within the last decade, the microRNA-371a-3p (miR371) emerged as a possible new biomarker with promising features. AREAS COVERED This review covers the typical features as well as possible clinical applications of miR371 in TGCT patients, such as initial diagnosis, therapy monitoring, and follow-up. Additionally, technical issues are discussed. EXPERT OPINION With a sensitivity of around 90% and specificity >90%, miR371 clearly outperforms the classical serum tumor markers in TGCTs. The unique features of the test involve the potential of modifying recent standards of care in TGCT. In particular, miR371 is expected to aid clinical decision-making in scenarios such as discriminating small testicular TGCT masses from benign ones prior to surgery, assessing equivocal lymphadenopathies, and monitoring chemotherapy results. Likewise, it is expected to make follow-up easier by reducing the intensity of examinations and by sparing imaging procedures. Overall, the data presently available are promising, but further prospective studies are required before the test can be implemented in standard clinical care.
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Affiliation(s)
- Tim Nestler
- Department of Urology, Federal Armed Forces Hospital Koblenz, 56072 Koblenz, Germany
| | - Justine Schoch
- Department of Urology, Federal Armed Forces Hospital Koblenz, 56072 Koblenz, Germany
| | - Gazanfer Belge
- Department of Tumour Genetics, University Bremen, 28359 Bremen, Germany
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Joel A, Singh A, Hepzibah J, Devasia A, Kumar S, Gnanamuthu BR, Chandramohan A, George AJP, John NT, Yadav B, John AO, Georgy JT, John S, Chacko RT. End-of-Treatment FDG PET-CT (EOT-PET) in Patients with Post-Chemotherapy Masses for Seminoma: Can We Avoid Further Intervention? South Asian J Cancer 2022; 11:315-321. [PMID: 36756102 PMCID: PMC9902077 DOI: 10.1055/s-0041-1735480] [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] [Indexed: 10/15/2022] Open
Abstract
Anjana JoelContext Patients with seminoma present with advanced disease. End-of-treatment (EOT) positron emission tomography-computed tomography (PET-CT) is done to assess response and direct management of post-chemotherapy residual masses. Purpose This article assesses the utility of EOT PET-CT in the management of post-chemotherapy residual lymph nodal masses seminoma. Materials and Methods We analyzed all patients with seminoma who underwent an EOT PET-CT from January 2015 to January 2020 at our center and calculated the positive predictive value (PPV) and negative predictive value (NPV) of EOT PET-CT in the entire cohort of patients and among subgroups. Results A total of 34 male patients underwent EOT PET-CT. Fourteen (41.2%) were stratified as good risk and 20 (58.8%) as intermediate risk. The median follow-up was 23 months (interquartile range: 9.75-53 months). In 23 patients there were residual masses of size more than 3 cm at the EOT PET scan. EOT PET was positive as per the SEMPET criteria in 18 (78%) out of 23 patients. None underwent retroperitoneal lymph node dissection. All four who underwent image-guided biopsy, showed only necrosis on pathology. One patient with positive mediastinal node (standardized uptake value 13.6) had granulomatous inflammation. There was no relapse or progression during this period of follow-up. The NPV for EOT PET-CT for the entire cohort, > 3 cm, and > 6 weeks cutoff were 100%, respectively. The PPV for EOT PET-CT for the entire cohort, > 3 cm residual mass, and > 6 weeks cutoff were 8.7, 11.11, and 6.67%, respectively. Conclusion EOT PET-CT has a low PPV and high NPV in predicting viable tumor in post-chemotherapy residual masses among patients with seminomatous germ cell tumors. If required, EOT PET positivity can be confirmed by a biopsy or reassessed with a repeat PET-CT imaging to document persistent disease prior to further intervention.
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Affiliation(s)
- Anjana Joel
- Department of Medical Oncology, Christian Medical College (CMC), Vellore, Tamil Nadu, India,Address for correspondence Anjana Joel, MD, DM Department of Medical Oncology Christian Medical College and HospitalVellore, Tamil NaduIndia
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Julie Hepzibah
- Department of Nuclear Medicine, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Antony Devasia
- Department of Urology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Santosh Kumar
- Department of Urology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Birla Roy Gnanamuthu
- Department of Thoracic Surgery, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Anuradha Chandramohan
- Department of Radiology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | | | - Nirmal Thampi John
- Department of Urology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Ajoy Oommen John
- Department of Medical Oncology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Josh Thomas Georgy
- Department of Medical Oncology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Subhashini John
- Department of Radiotherapy, Christian Medical College (CMC), Vellore, Tamil Nadu, India
| | - Raju Titus Chacko
- Department of Medical Oncology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
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Dieckmann KP, Klemke M, Grobelny F, Radtke A, Dralle-Filiz I, Wülfing C, Belge G. Serum Levels of MicroRNA-371a-3p (M371) Can Predict Absence or Presence of Vital Disease in Residual Masses After Chemotherapy of Metastatic Seminoma. Front Oncol 2022; 12:889624. [PMID: 35600346 PMCID: PMC9121896 DOI: 10.3389/fonc.2022.889624] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundRadiological evaluation of postchemotherapy residual masses of metastatic seminoma is characterized by poor diagnostic accuracy. Serum levels of microRNA-371a-3p (M371) involve high specificity and sensitivity for the primary diagnosis of seminoma. We evaluated if M371 levels can indicate the presence of vital disease in postchemotherapy residual masses in patients with metastatic seminoma.MethodsTwenty-three seminoma patients (median age 52 years) with residual masses had posttreatment measurements of serum M371 levels (group A), fourteen of whom had measurements also beforehand. The posttreatment results were compared with the clinical outcome during follow-up. Eleven patients with complete remission after treatment of metastatic seminoma (group B) and 33 men with non-malignant testicular diseases (group C) served as controls. M371 serum levels were measured by quantitative real-time PCR using miR-30b-5p as endogenous control. An evaluation was performed with descriptive statistical methods.ResultsTwenty-two patients of Group A had uneventful follow-up so far, twenty-one of whom had M371 level <5, and one other had a mildly elevated level below relative quantity (RQ) = 10. One patient with a level of RQ = 26.2 rapidly progressed. The median posttreatment M371 level of the non-progressing patients of group A is not significantly different from the median level of the control group with complete remission (B). Before treatment, the median M371 levels in groups A and B were 507.6 and 143.9, respectively. In both groups, significant drops in M371 levels resulted from treatment.ConclusionNormal M371 serum levels at the time of completion of treatment of metastatic seminoma indicate the absence of vital seminoma in residual masses, while elevated levels >RQ = 10 predict the presence of disease. The optimal timing of M371 measurement after chemotherapy and the appropriate cutoff level still need to be determined. Based on the present results, measuring serum M371 levels involves the potential of a novel tool for assessing postchemotherapy residual masses of metastatic seminoma.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| | - Markus Klemke
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
| | | | | | | | | | - Gazanfer Belge
- Faculty of Biology & Chemistry, University of Bremen, Bremen, Germany
- *Correspondence: Gazanfer Belge,
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Abstract
PURPOSE OF REVIEW Although testicular cancer remains a highly curable malignancy, challenges and uncertainty still remain in certain aspects of management. Residual disease after chemotherapy in patients with germ cell tumors (GCT) remains one of these challenges. We aim to highlight the recent literature on the management of residual disease after chemotherapy in GCT and the emerging innovations that may provide further guidance into this area. RECENT FINDINGS A subset of patients with GCT will have residual disease after chemotherapy, and management of these patients involves highly skilled multidisciplinary experts including medical oncologists, surgeons, radiologists, and pathologists. Management options depend on histologic subtype, either seminoma or nonseminoma, and involve size criteria, possible further imaging modalities, and tumor markers. Even with these tools at highly specialized expert centers, uncertainty in management remains, and recent literature has explored the use of newer biomarkers to aid in these cases. SUMMARY Postchemotherapy residual masses in GCT can prove to be complicated cases to manage. Balancing survival with quality of life outcomes is important and requires a multidisciplinary team experienced in treating GCT.
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Daneshmand S. Advanced Testis Cancer. Eur Urol Focus 2019; 5:710-712. [PMID: 31563547 DOI: 10.1016/j.euf.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
Management of advanced testis cancer requires dedicated attention to the nuances of the disease to not only optimize cure but also ensure lifelong health. We are rapidly entering an era of precision medicine with novel biomarker discoveries that will undoubtedly change the treatment paradigm in both early- and late-stage disease.
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Affiliation(s)
- Siamak Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Parimi S, Rauw JM, Ko JJ. Systemic Therapies for Metastatic Testicular Germ Cell Tumors: Past, Present and Future. CURRENT CANCER THERAPY REVIEWS 2019. [DOI: 10.2174/1573394714666180706150427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Testicular germ cell tumors (TGCTs) are unique to that of most other solid tumors because
they are highly curable in the metastatic setting. While the use of cisplatin-based chemotherapy
continues to drive cure in this patient population, important improvements in the delivery
of therapy, creation of risk-adjusted treatment paradigms, and salvage-therapy options have further
enhanced survival as well. The future holds promise for a more multidisciplinary approach to
care, through advancements in biochemical markers and a better understanding of how surgical
and radiotherapy approaches can integrate into our existing management strategies.
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Affiliation(s)
- Sunil Parimi
- BC Cancer Agency, 2410 Lee Avenue, Victoria, BC, V8R 4X1, Canada
| | - Jennifer M. Rauw
- BC Cancer Agency, 2410 Lee Avenue, Victoria, BC, V8R 4X1, Canada
| | - Jenny J. Ko
- BC Cancer Agency, 32900 Marshall Rd, Abbotsford, BC, V2S 0C2, Canada
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Heidenreich A, Paffenholz P, Nestler T, Pfister D. Management of residual masses in testicular germ cell tumors. Expert Rev Anticancer Ther 2019; 19:291-300. [PMID: 30793990 DOI: 10.1080/14737140.2019.1580146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION About 50% of all patients with advanced testicular cancer demonstrate residual retroperitoneal or extraretroperitoneal masses. About two thirds of the masses harbour necrosis/fibrosis only whereas as about 10% and 40% harbour vital cancer or teratoma. Appropriate therapy will result in a high cure rate if performed properly. Areas covered: This review article covers the indication, the surgical technique and the oncological outcome of PC-RPLND and resection of extraretroperitoneal residual masses following chemotherapy in patients with advanced testis cancer. Expert commentary: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an integral part of the multimodality treatment in patients with advanced testicular germ cell tumours. Patients with nonseminomas, residual masses < 1cm and good prognosis can undergo active surveillance. In all other cases, PC-RPLND with or without resection of adjacent organs needs to be performed for curative intent. PC-RPLND requires a complex surgical approach and should be performed in experienced, tertiary referral centres only.
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Affiliation(s)
- Axel Heidenreich
- a Department of Urology, Urologic Oncology, Robot-assisted and Specialized Urologic Surgery , University Hospital Cologne , Köln , Germany
| | - Pia Paffenholz
- a Department of Urology, Urologic Oncology, Robot-assisted and Specialized Urologic Surgery , University Hospital Cologne , Köln , Germany
| | - Tim Nestler
- a Department of Urology, Urologic Oncology, Robot-assisted and Specialized Urologic Surgery , University Hospital Cologne , Köln , Germany
| | - David Pfister
- a Department of Urology, Urologic Oncology, Robot-assisted and Specialized Urologic Surgery , University Hospital Cologne , Köln , Germany
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Current controversies on the role of lymphadenectomy for testicular cancer for the journal: Urologic Oncology: Seminars and Original Investigations for the special seminars section on the role of lymphadenectomy for urologic cancers. Urol Oncol 2019; 39:698-703. [PMID: 30630731 DOI: 10.1016/j.urolonc.2018.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 12/04/2018] [Accepted: 12/22/2018] [Indexed: 11/22/2022]
Abstract
The role of surgery in the locoregional management of many solid tumors has long been established. For testicular cancer, the incorporation of lymphadenectomy has played an important part in generating long-term survival outcomes in excess of 90% for germ cell tumor patients. In this review, we address several clinical scenarios in which lymphadenectomy at times is underutilized, and others ill advised.
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Heidenreich A, Pfister D. Postchemotherapy Retroperitoneal Lymph Node Dissection in Advanced Germ Cell Tumors of the Testis. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_9-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Heidenreich A, Pfister D. Postchemotherapy Retroperitoneal Lymph Node Dissection in Advanced Germ Cell Tumors of the Testis. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_9] [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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Cathomas R, Klingbiel D, Bernard B, Lorch A, Garcia Del Muro X, Morelli F, De Giorgi U, Fedyanin M, Oing C, Haugnes HS, Hentrich M, Fankhauser C, Gillessen S, Beyer J. Questioning the Value of Fluorodeoxyglucose Positron Emission Tomography for Residual Lesions After Chemotherapy for Metastatic Seminoma: Results of an International Global Germ Cell Cancer Group Registry. J Clin Oncol 2018; 36:JCO1800210. [PMID: 30285559 DOI: 10.1200/jco.18.00210] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Residual lesions after chemotherapy are frequent in metastatic seminoma. Watchful waiting is recommended for lesions < 3 cm as well as for fluorodeoxyglucose (FDG) positron emission tomography (PET)-negative lesions ≥ 3 cm. Information on the optimal management of PET-positive residual lesions ≥ 3 cm is lacking. PATIENTS AND METHODS We retrospectively identified 90 patients with metastatic seminoma with PET-positive residual lesions after chemotherapy. Patients with elevated α-fetoprotein or nonseminomatous histology were excluded. We analyzed the post-PET management and its impact on relapse and survival and calculated the positive predictive value (PPV) for PET. RESULTS Median follow-up time was 29 months (interquartile range [IQR], 10 to 62 months). Median diameter of the largest residual mass was 4.9 cm (range, 1.1 to 14 cm), with masses located in the retroperitoneum (77%), pelvis (16%), mediastinum (17%), and/or lung (3%). Median time from the last day of chemotherapy to PET was 6.9 weeks (IQR, 4.4 to 9.9 weeks). Post-PET management included repeated imaging in 51 patients (57%), resection in 26 patients (29%), biopsy in nine patients (10%) and radiotherapy in four patients (4%). Histology of the resected specimen was necrosis in 21 patients (81%) and vital seminoma in five patients (19%). No biopsy revealed vital seminoma. Relapse or progression occurred in 15 patients (17%) after a median of 3.7 months (IQR, 2.5 to 4.9 months) and was found in 11 (22%) of 51 patients on repeated imaging, in two (8%) of 26 patients after resection, and in two (22%) of nine patients after biopsy. All but one patient who experienced relapse were successfully treated with salvage therapy. The PPV for FDG-PET was 23%. CONCLUSION FDG-PET has a low PPV for vital tumor in residual lesions after chemotherapy in patients with metastatic seminoma. This cautions against clinical decisions based on PET positivity alone.
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Affiliation(s)
- Richard Cathomas
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Dirk Klingbiel
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Brandon Bernard
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Anja Lorch
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Xavier Garcia Del Muro
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Franco Morelli
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Ugo De Giorgi
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Mikhail Fedyanin
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Christoph Oing
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Hege Sagstuen Haugnes
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Marcus Hentrich
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Christian Fankhauser
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Silke Gillessen
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
| | - Jörg Beyer
- Richard Cathomas, Kantonsspital Graubünden, Chur; Dirk Klingbiel, Swiss Group for Clinical Cancer Research Coordinating Center; Silke Gillessen, University of Bern; Jörg Beyer, Inselspital, Bern University Hospital, University of Bern, Bern; Christian Fankhauser, University of Zürich, Zürich; Silke Gillessen, Kantonsspital St Gallen, St Gallen, Switzerland; Brandon Bernard, Dana-Farber Cancer Institute, Boston, MA; Anja Lorch, University of Düsseldorf, Düsseldorf; Christoph Oing, University Medical Center Hamburg-Eppendorf, Hamburg; Marcus Hentrich, Rotkreuzklinikum München, München, Germany; Xavier Garcia del Muro, Institute Catalan of Oncology, Bellvitge Biomedical Research Institute, University of Barcelona, Barcelona, Spain; Franco Morelli, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo; Ugo De Giorgi, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Meldola, Italy; Mikhail Fedyanin, N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia; and Hege Sagstuen Haugnes, University Hospital of North Norway and Universitetet i Tromsø-The Arctic University, Tromsø, Norway
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Contemporary trends in postchemotherapy retroperitoneal lymph node dissection: Additional procedures and perioperative complications. Urol Oncol 2015; 33:389.e15-21. [DOI: 10.1016/j.urolonc.2014.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 01/22/2023]
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13
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Pfister D, Porres D, Matveev V, Heidenreich A. Reduzierte Morbidität bei der Resektion von Residualtumoren nach Chemotherapie beim Seminom. Urologe A 2015; 54:1402-6. [DOI: 10.1007/s00120-014-3708-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Survival Analysis of Pure Seminoma at Post-Chemotherapy Retroperitoneal Lymph Node Dissection. J Urol 2014; 192:1397-402. [DOI: 10.1016/j.juro.2014.04.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/21/2022]
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15
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Risk MC, Foster RS. Postchemotherapy retroperitoneal lymph node dissection for testis cancer. Expert Rev Anticancer Ther 2014; 11:95-106. [DOI: 10.1586/era.10.206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Domont J, Massard C, Patrikidou A, Bossi A, de Crevoisier R, Rose M, Wibault P, Fizazi K. A risk-adapted strategy of radiotherapy or cisplatin-based chemotherapy in stage II seminoma. Urol Oncol 2013; 31:697-705. [DOI: 10.1016/j.urolonc.2011.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 04/11/2011] [Accepted: 04/13/2011] [Indexed: 11/29/2022]
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Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol 2012; 4:187-205. [PMID: 22852029 DOI: 10.1177/1756287212443170] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Clinical stage I testicular nonseminomatous germ cell tumours (NSGCTs) are highly curable. Following orchidectomy a risk-adapted approach using active surveillance (AS), nerve-sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy is recommended by the current guidelines. Clinical stage I is defined as negative or declining tumour markers to their half-life following orchidectomy and negative imaging studies of the chest, abdomen and retroperitoneum. Active surveillance can be performed in low-risk and in high-risk NSGCTs with an anticipated relapse rate of about 15% and 50%. The majority of patients will relapse with good and intermediate prognosis tumours which have to be treated with three to four cycles chemotherapy. About 25-30% of these patients will have to undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for residual masses. Primary chemotherapy with one or two cycles of cisplatin (Platinol), etoposide and bleomycin (PEB) is a therapeutic option for high-risk clinical stage I NSGCT associated with a recurrence rate of only 2-3% and a minimal acute and long-term toxicity rate. nsRPLND, if performed properly, will cure about 85% of all high-risk patients with clinical stage I NSGCT without the need for chemotherapy. PC-RPLND forms an integral part of the multimodality treatment in patients with advanced testicular germ cell tumours (TGCTs). According to current guidelines and recommendations, PC-RPLND in advanced seminomas with residual tumours is only indicated if a positron emission tomography (PET) scan performed 6-8 weeks after chemotherapy is positive. In nonseminomatous TGCT, PC-RPLND is indicated for all residual radiographic lesions with negative or plateauing markers. Loss of antegrade ejaculation represents the most common long-term complication which can be prevented by a nerve-sparing or modified template resection. The relapse rate after PC-RPLND is around 12%, however it increases significantly to about 45% in cases with redo RPLND and late relapses. Patients with increasing markers should undergo salvage chemotherapy. Only select patients with elevated markers who are thought to be chemorefractory might undergo desperation PC-RPLND if all radiographically visible lesions are completely resectable. PC-RPLND requires a complex surgical approach and should be performed in experienced, tertiary referral centres only.
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Affiliation(s)
- Axel Heidenreich
- Director and Chairman, EURO Prostate Center, Department of Urology, Urologic Oncology, Pediatric Urology and Renal Transplantation, RWTH University Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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Siekiera J, Małkowski B, Jóźwicki W, Jasiński M, Wronczewski A, Pietrzak T, Chmielowska E, Petrus A, Kamecki K, Mikołajczak W, Kraśnicki K, Chłosta P, Drewa T. Can We Rely on PET in the Follow-Up of Advanced Seminoma Patients? Urol Int 2012; 88:405-9. [DOI: 10.1159/000337056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 01/21/2012] [Indexed: 11/19/2022]
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19
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Bachner M, Loriot Y, Gross-Goupil M, Zucali PA, Horwich A, Germa-Lluch JR, Kollmannsberger C, Stoiber F, Fléchon A, Oechsle K, Gillessen S, Oldenburg J, Cohn-Cedermark G, Daugaard G, Morelli F, Sella A, Harland S, Kerst M, Gampe J, Dittrich C, Fizazi K, De Santis M. 2-¹⁸fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) for postchemotherapy seminoma residual lesions: a retrospective validation of the SEMPET trial. Ann Oncol 2012; 23:59-64. [PMID: 21460378 DOI: 10.1093/annonc/mdr052] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND 2-¹⁸fluoro-deoxy-D-glucose positron emission tomography (FDG-PET) has been recommended in international guidelines in the evaluation of postchemotherapy seminoma residuals. Our trial was designed to validate these recommendations in a larger group of patients. PATIENTS AND METHODS FDG-PET studies in patients with metastatic seminoma and residual masses after platinum-containing chemotherapy were correlated with either the histology of the resected lesion(s) or the clinical outcome. RESULTS One hundred and seventy seven FDG-PET results were contributed. Of 127 eligible PET studies, 69% were true negative, 11% true positive, 6% false negative, and 15% false positive. We compared PET scans carried out before and after a cut-off level of 6 weeks after the end of the last chemotherapy cycle. PET sensitivity, specificity, negative predictive value (NPV), and positive predictive value were 50%, 77%, 91%, and 25%, respectively, before the cut-off and 82%, 90%, 95%, and 69% after the cut-off. PET accuracy significantly improved from 73% before to 88% after the cut-off (P=0.032). CONCLUSION Our study confirms the high specificity, sensitivity, and NPV of FDG-PET for evaluating postchemotherapy seminoma residuals. When carried out at an adequate time point, FDG-PET remains a valuable tool for clinical decision-making in this clinical setting and spares patients unnecessary therapy.
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Affiliation(s)
- M Bachner
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria
| | - Y Loriot
- Institut Gustave Roussy, Villejuif, France
| | | | - P A Zucali
- Istituto Clinico Humanitas IRCCS, Rozzano (Milan), Italian Germ Cell Cancer Group
| | - A Horwich
- The Royal Marsden Hospital, London and Surrey, UK
| | | | | | - F Stoiber
- Krankenhaus der Barmherzigen Schwestern, Linz, Austria
| | | | - K Oechsle
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - S Gillessen
- Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, 5073 Rigshospitalet, Copenhagen, Denmark
| | - F Morelli
- Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - A Sella
- Assaf Harofeh Medical Center, Zerifin, Israel
| | - S Harland
- University College Hospital London, London, UK
| | - M Kerst
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Gampe
- Max Planck Institute for Demographic Research, Rostock, Germany
| | - C Dittrich
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria
| | - K Fizazi
- Institut Gustave Roussy, Villejuif, France
| | - M De Santis
- ACR-ITR VIEnna/CEADDP, LBI-ACR VIEnna, and KFJ-Spital, Vienna, Austria.
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Müller J, Schrader AJ, Jentzmik F, Schrader M. [Assessment of residual tumours after systemic treatment of metastatic seminoma: ¹⁸F-2-fluoro-2-deoxy-D-glucose positron emission tomography - meta-analysis of diagnostic value]. Urologe A 2011; 50:322-7. [PMID: 21161157 DOI: 10.1007/s00120-010-2469-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Meta-analysis evaluating the accuracy and sensitivity of FDG (2-[(18)F]-fluoro-2-deoxy-D-glucose) positron emission tomography (PET) to predict viable residual tumours in patients with metastatic seminoma. MATERIAL AND METHODS Altogether 5 studies with 130 patients were identified. Both FDG PET and the size of the residual lesions on conventional computed tomography (CT; lesions either ≤ or > 3 cm) were correlated with the presence or absence of viable residual tumour. RESULTS The specificity (92 vs 59%), sensitivity (72 vs 63%), positive (70 vs 28%) and negative (93 vs 86%) predictive value of FDG PET were superior to data obtained by assessing residual tumour size (either ≤ or > 3 cm) applying CT scans alone. CONCLUSION In view of the data currently available, FDG PET seems to be a clinically useful predictor of viable tumour in post-chemotherapy residuals of pure seminoma.
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Affiliation(s)
- J Müller
- Klinik für Urologie, Universitätsklinikum Ulm, Pritzwitzstraße 43, 89075 Ulm, Deutschland.
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Boujelbene N, Cosinschi A, Boujelbene N, Khanfir K, Bhagwati S, Herrmann E, Mirimanoff RO, Ozsahin M, Zouhair A. Pure seminoma: a review and update. Radiat Oncol 2011; 6:90. [PMID: 21819630 PMCID: PMC3163197 DOI: 10.1186/1748-717x-6-90] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/08/2011] [Indexed: 03/27/2023] Open
Abstract
Pure seminoma is a rare pathology of the young adult, often discovered in the early stages. Its prognosis is generally excellent and many therapeutic options are available, especially in stage I tumors. High cure rates can be achieved in several ways: standard treatment with radiotherapy is challenged by surveillance and chemotherapy. Toxicity issues and the patients' preferences should be considered when management decisions are made. This paper describes firstly the management of primary seminoma and its nodal involvement and, secondly, the various therapeutic options according to stage.
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Affiliation(s)
- Noureddine Boujelbene
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
- Department of Radiation Oncology, Centre Hospitalier Universitaire Habib Bourguiba, 3000 Sfax, Tunisia
- Department of Radiation Oncology, Hôpital de Sion-CHCVs, CH-1950 Sion, Switzerland
| | - Adrien Cosinschi
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Nadia Boujelbene
- Department of Pathology, Institut Gustave-Roussy, 94805 Villejuif, France
- Department of Pathology, Hôpital HabibThameur, 1089 Tunis, Tunisia
| | - Kaouthar Khanfir
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
- Department of Radiation Oncology, Hôpital de Sion-CHCVs, CH-1950 Sion, Switzerland
| | - Shushila Bhagwati
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Eveleyn Herrmann
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Rene-Olivier Mirimanoff
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Abderrahim Zouhair
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Bugnon 46, CH-1011 Lausanne, Switzerland
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Boujelbene N, Ozsahin M, Khanfir K, Azria D, Mirimanoff RO, Zouhair A. [What's new in the treatment of seminomas?]. Cancer Radiother 2011; 15:208-20. [PMID: 21414829 DOI: 10.1016/j.canrad.2010.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 09/01/2010] [Accepted: 09/30/2010] [Indexed: 10/18/2022]
Abstract
Pure testicular seminoma is a rare disease with an excellent prognosis. Its management is controversial. In stage I disease, several treatment options are considered. Those are radiation therapy alone, chemotherapy alone or active surveillance, which is becoming increasingly popular. For more advanced stages, treatment is based on chemotherapy with or without radiation therapy. In this article, we review thoroughly the existing literature and recent recommendations the various treatment options, their advantages and disadvantages in different stages of the disease.
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Affiliation(s)
- N Boujelbene
- Service de radio-oncologie, CHU vaudois, Lausanne, Suisse
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23
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Mueller J, Schnoeller T, Zengerling F, Waalkes S, Ghazal AA, Jentzmik F, Schrader M, Schrader AJ. Meta-Analysis to Determine the Diagnostic Value of 2-<sup>18</sup>Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Assessing Residual Tumors after Systemic Therapy for Metastatic Seminoma. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/oju.2011.13011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kawai K, Akaza H. Current status of chemotherapy in risk-adapted management for metastatic testicular germ cell cancer. Cancer Sci 2010; 101:22-8. [PMID: 19922501 PMCID: PMC11159163 DOI: 10.1111/j.1349-7006.2009.01373.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Today, approximately 80% of men with metastatic testicular cancer can be cured with chemotherapy combined with the appropriate surgery. The improved treatment outcome has led to the stratification of patients with metastatic disease by the consensus prognostic index; the International Germ Cell Cancer Consensus Group classification. Currently, the first-line chemotherapy with bleomycin, etoposide, and cisplatin (BEP) remains the standard management of metastatic testicular cancer. Three cycles of BEP for good-prognosis patients and four cycles of BEP for intermediate- and poor-prognosis patients are the standard first-line chemotherapy. To achieve the optimal outcome, BEP should be given with appropriate supportive care and risk assessment for toxicity. Although no universal prognostic criteria have been defined for the recurrent or refractory disease, the risk-adapted approach may clarify the role of ifosfamide- and paclitaxel-containing conventional-dose chemotherapy or high-dose chemotherapy in the second-line setting. Several investigators reported recent improvement of treatment outcome of testicular cancer patients, especially those with poor prognosis. Along with the progress in chemotherapy, the risk-adapted management at experienced hospitals seems to be responsible for the recent progress in treatment outcome.
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Affiliation(s)
- Koji Kawai
- Department of Urology, Institute of Clinical Medicine, University of Tsukuba Graduate School of Comprehensive Human Sciences, Tsukuba, Ibaraki, Japan.
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Delbeke D, Schöder H, Martin WH, Wahl RL. Hybrid imaging (SPECT/CT and PET/CT): improving therapeutic decisions. Semin Nucl Med 2009; 39:308-40. [PMID: 19646557 DOI: 10.1053/j.semnuclmed.2009.03.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The incremental diagnostic value of integrated positron emission tomography-computed tomography (PET/CT) or single-photon emission computed tomography (SPECT)/CT images compared with PET or SPECT alone, or PET or SPECT correlated with a CT obtained at a different time includes the following: (1) improvement in lesion detection on both CT and PET or SPECT images, (2) improvement in the localization of foci of uptake resulting in better differentiation of physiological from pathologic uptake, (3) precise localization of the malignant foci, for example, in the skeleton vs soft tissue or liver vs adjacent bowel or node (4) characterization of serendipitous lesions, and (5) confirmation of small, subtle, or unusual lesions. The use of these techniques can occur at the time of initial diagnosis, in assessing the early response of disease to treatment, at the conclusion of treatment, and in continuing follow-up of patients. PET/CT and SPECT/CT fusion images affect the clinical management in a significant proportion of patients with a wide range of diseases by (1) guiding further procedures, (2) excluding the need of further procedures, (3) changing both inter- and intramodality therapy, including soon after treatment has been initiated, and (4) by providing prognostic information. PET/CT fusion images have the potential to provide important information to guide the biopsy of a mass to active regions of the tumor and to provide better maps than CT alone to modulate field and dose of radiation therapy. It is expected that the role of PET/CT and SPECT/CT in changing management will continue to evolve in the future and that these tools will be fundamental components of the truly "personalized medicine" we are striving to deliver.
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Affiliation(s)
- Dominique Delbeke
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675, USA.
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Rodeberg DA, Stoner JA, Hayes-Jordan A, Kao SC, Wolden SL, Qualman SJ, Meyer WH, Hawkins DS. Prognostic significance of tumor response at the end of therapy in group III rhabdomyosarcoma: a report from the children's oncology group. J Clin Oncol 2009; 27:3705-11. [PMID: 19470937 DOI: 10.1200/jco.2008.19.5933] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Some patients with rhabdomyosarcoma (RMS) achieve less than a complete response (CR) despite receiving all planned therapy. We assessed the impact of best response at the completion of all therapy on patient outcome. PATIENTS AND METHODS We studied 419 clinical group III participants who completed all protocol therapy without developing progressive disease for Intergroup Rhabdomyosarcoma Study (IRS) IV. Response (complete resolution [CR], partial response [PR; > or = 50% decrease], or no response [NR; < 50% decrease and < 25% increase]) was determined by radiographic measurement and categorized by the best response. RESULTS At the end of therapy, 341 participants (81%) achieved a best response of CR and 78 (19%) had a best response of PR/NR. Five-year failure-free survival was similar for participants achieving CR (80%) and PR/NR (78%). After adjustment for age, nodal status, primary site, and histology, there was no significant indication of lower risk of failure (hazard ratio [HR], 0.77; 95% CI, 0.46 to 1.27; P = .3) nor death (HR, 0.63; 95% CI, 0.36 to 1.09; P = .1) for CR versus PR/NR participants. Seventeen participants with a best response of PR/NR had surgical procedures; eight (50%) of 16 with available pathology reports had residual viable tumor and only three achieved a complete resection. Resection of residual masses was not associated with improved outcome. CONCLUSION CR status at the end of protocol therapy in clinical group III participants was not associated with a reduction of disease recurrence and death. Aggressive alternative therapy may not be warranted for RMS patients with a residual mass at the end of planned therapy.
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Affiliation(s)
- David A Rodeberg
- University of Pittsburgh School of Medicine, Department of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2585, USA.
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Oldenburg J, Wahlqvist R, Fosså SD. Late relapse of germ cell tumors. World J Urol 2009; 27:493-500. [PMID: 19373473 DOI: 10.1007/s00345-009-0411-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 03/26/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the main characteristics of late relapsing malignant germ cell tumors (MGCTs). These tumors are rare and occur by definition 2 years or later after successful treatment. METHODS We present relevant literature on relapsing MGCT in order to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival. RESULTS A pooled analysis of 5,880 patients with MGCT revealed late relapses in 119 of 3,704 (3.2%) and in 31 of 2,176 (1.4%) patients with non-seminoma and seminoma, respectively. The retroperitoneal space is the predominant site of relapse in both histological types. The initial treatment is important for the risk and localization of late relapses. Patients with single site teratoma are usually cured by surgery alone, whereas viable MGCT or teratoma with malignant transformation may require multimodal treatment with chemo- and/or radiotherapy as well as surgery. Surgery is the most important part in the treatment of late relapses. Salvage chemotherapy should, if feasible, be based on a representative biopsy. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single site teratoma. CONCLUSIONS Treatment of late relapsing MGCT patients is challenging and should be performed in experienced centers only. Referral of late relapsing patients to high-volume institutions ensures the best chances of cure and enables multimodal treatment, and contributes to increased knowledge of tumor biology as well experience with the clinical course of these patients.
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Affiliation(s)
- Jan Oldenburg
- Department of Medical Oncology, The Norwegian Radium Hospital, Oslo, Norway,
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Abstract
The treatment options in metastatic testicular germ cell cancer are based on prognostic the factor-based staging system from IGCCCG. Since 1987 (!), the optimal chemotherapy regimen has been BEP with a weekly administration of 30 mg of bleomycine, and a 3 or 5-day schedule of 500 mg/m(2) etoposide and 100 mg/m(2) cisplatin. Dose reduction of this regimen or use of carboplatin provide lower efficacy and should be abandoned. As a first line treatment, 3 cycles of BEP should be used in good-risk metastatic nonseminomatous germ cell tumours whereas 4 cycles of BEP are mandatory in poor-risk nonseminomatous cancers. No other chemotherapy regimen has proven superior efficacy. In the lack of specific controlled studies, metastatic seminoma should be treated as nonseminomatous tumours. As second line treatment, VeIP, high-dose chemotherapy with autologous stem cell transplantation and paclitaxel are the main options. Precise predictive factors of recurrence are needed to better define indications of first and other lines of treatment in specific situations such as non-resected residual seminoma.
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Postchemotherapy Retroperitoneal Lymph Node Dissection in Advanced Germ Cell Tumours of the Testis. Eur Urol 2008; 53:260-72. [PMID: 18045770 DOI: 10.1016/j.eururo.2007.10.033] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 10/19/2007] [Indexed: 11/27/2022]
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Hinz S, Schrader M, Kempkensteffen C, Bares R, Brenner W, Krege S, Franzius C, Kliesch S, Heicappel R, Miller K, de Wit M. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol 2008; 179:936-40; discussion 940. [PMID: 18207171 DOI: 10.1016/j.juro.2007.10.054] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE Treatment in patients with seminoma who have residual or recurrent masses following chemotherapy is still a matter of debate. Surgical resection is currently the most common recommendation for masses greater than 3 cm, resulting in overtreatment in up to 70% of those affected. We analyzed the accuracy of preoperative positron emission tomography for predicting viable tumor residuals in patients with seminoma. MATERIALS AND METHODS In a prospective, multicenter trial computerized tomography and FDG (2-(F-18)-fluoro-2-deoxy-D-glucose) positron emission tomography were performed before surgical resection for residual or recurrent masses in 20 patients who had undergone chemotherapy for stage IIb, IIc or III seminoma. Histopathological findings were directly correlated with positron emission tomography results. RESULTS Of the patients 18 presented with residual masses and 2 had recurrent masses following chemotherapy. Histopathological assessment revealed viable tumor in 3 patients and benign lesions in 17. All patients with viable tumor were identified correctly by positron emission tomography. No false-negative results were observed but 9 patients had false-positive positron emission tomography results. This resulted in a negative predictive value of 1 (95% CI 0.63-1) and a positive predictive value of 0.25 (95% CI 0.05-0.57) for FDG-positron emission tomography in our patient cohort. CONCLUSIONS Our data indicate that FDG-positron emission tomography is capable of excluding viable disease in residual masses, even those exceeding 3 cm. Therefore, it may be considered an additional tool to improve patient counseling. However, the decision to perform surgical resection of the residual mass should not be based exclusively on a positive positron emission tomography image since false-positive results appear to be common.
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Affiliation(s)
- Stefan Hinz
- Department of Urology, Charité Campus Benjamin Franklin, Universitaetsmedizin Berlin, Berlin, Germany.
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Imaging the Male Reproductive Tract: Current Trends and Future Directions. Radiol Clin North Am 2008; 46:133-47, vii. [DOI: 10.1016/j.rcl.2008.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mottet N, Culine S, Iborra F, Avances C, Bastide C, Lesourd A, Michel F, Rigaud J. Tumeurs du Testicule. Prog Urol 2007; 17:1035-45. [DOI: 10.1016/s1166-7087(07)74779-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sim HG, Lange PH, Lin DW. Role of post-chemotherapy surgery in germ cell tumors. Urol Clin North Am 2007; 34:199-217; abstract ix. [PMID: 17484925 DOI: 10.1016/j.ucl.2007.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Surgery after systemic chemotherapy for advanced testicular cancer has maintained its role in staging and therapeutic management. The clinical outcome is strongly influenced by patient selection and extent of extirpative surgery. Although extensive predictive modeling has attempted to define appropriate post-chemotherapy surgical candidates based on various clinical and pathologic parameters, the accuracy of these models remains controversial. Complete removal of all post-chemotherapy residual masses in nonseminomatous germ cell tumors remains the standard of care and allows for improved prognostication of the long-term oncologic and functional outcome.
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Affiliation(s)
- Hong Gee Sim
- Department of Urology, University of Washington, Seattle, WA 98195, USA
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34
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Fléchon A, Droz JP. [Testis germ cell tumours: which chemotherapy, for which patients?]. ACTA ACUST UNITED AC 2007; 41:56-67. [PMID: 17486913 DOI: 10.1016/j.anuro.2006.12.005] [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: 11/17/2022]
Abstract
Germ cell tumours of the testis are curable disease. Two different pathological subtypes are observed: seminoma and non-seminoma. Two tumour stages have been defined: the disease limited to the testis and the advanced disease. In the latter group, the prognosis is established by a specific classification based on the level of serum tumour marker and the location of the metastases. The most active first line chemotherapy is a combination of bleomycine, etoposide and cisplatine. Patients with good prognostic factors receive three cycles of this regimen; patients with poor-risk characteristics receive four cycles of the same regimen. The strategy in non-seminoma patients is to give a first-line chemotherapy adapted to the risk factors, then to complete surgical exeresis of all residual disease. Patients with stage I disease may receive two cycles of the same regimen. The strategy for advanced seminoma is to give first-line good-risk chemotherapy followed by a close observation and in several selected cases a surgical removal of all residual disease. Patients with stage I disease may receive one cycle of carboplatin. Salvage chemotherapy is based on the combination of ifosfamide, cisplatine and either vinblastine or paclitaxel.
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MESH Headings
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Agents, Alkylating/therapeutic use
- Antineoplastic Agents, Phytogenic/administration & dosage
- Antineoplastic Agents, Phytogenic/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bleomycin/administration & dosage
- Bleomycin/therapeutic use
- Cisplatin/administration & dosage
- Cisplatin/therapeutic use
- Etoposide/administration & dosage
- Etoposide/therapeutic use
- Humans
- Ifosfamide/administration & dosage
- Ifosfamide/therapeutic use
- Lymphatic Metastasis
- Male
- Neoplasm Staging
- Neoplasm, Residual/surgery
- Neoplasms, Germ Cell and Embryonal/diagnostic imaging
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/pathology
- Neoplasms, Germ Cell and Embryonal/surgery
- Paclitaxel/administration & dosage
- Paclitaxel/therapeutic use
- Positron-Emission Tomography
- Prognosis
- Randomized Controlled Trials as Topic
- Risk Factors
- Seminoma/diagnostic imaging
- Seminoma/drug therapy
- Seminoma/pathology
- Seminoma/surgery
- Testicular Neoplasms/diagnostic imaging
- Testicular Neoplasms/drug therapy
- Testicular Neoplasms/pathology
- Testicular Neoplasms/surgery
- Testis/pathology
- Vinblastine/administration & dosage
- Vinblastine/therapeutic use
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Affiliation(s)
- A Fléchon
- Département de cancérologie médicale, Centre Lóon-Bérard, 28, rue Laënnec, 69008 Lyon, France
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Lewis DA, Tann M, Kesler K, McCool A, Foster RS, Einhorn LH. Positron emission tomography scans in postchemotherapy seminoma patients with residual masses: a retrospective review from Indiana University Hospital. J Clin Oncol 2006; 24:e54-5. [PMID: 17135635 DOI: 10.1200/jco.2006.08.1737] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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36
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Oldenburg J, Martin JM, Fosså SD. Late Relapses of Germ Cell Malignancies: Incidence, Management, and Prognosis. J Clin Oncol 2006; 24:5503-11. [PMID: 17158535 DOI: 10.1200/jco.2006.08.1836] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Late relapses of malignant germ cell tumors (MGCTs) are rare and occur, by definition, 2 years or later after successful treatment. They represent a major challenge of today's treatment of MGCTs. Because of the rarity and heterogeneity of late relapses, many aspects of their main characteristics remain obscure. We present relevant literature on relapsing MGCTs to highlight the following issues: incidence, impact of initial treatment on the subsequent risk of late relapse, treatment, and survival. In a pooled analysis, the incidence is 1.4% and 3.2% in seminoma and nonseminoma patients, respectively. The predominant site of relapse is the retroperitoneal space in both histologic types. The initial treatment appears to be important for the risk and localization of late relapses. The treatment of late relapses should be based on a representative presalvage biopsy and includes radical surgery and salvage chemotherapy in most cases. Five-year cancer-specific survival is above 50% in the recent large series and reaches 100% in case of single-site teratoma. Diagnosis and treatment of late-relapsing MGCT patients is challenging and should be performed in experienced centers only. Referral of late-relapsing patients to high-volume institutions ensures the best chances of cure and enables increasing understanding of tumor biology and the clinical course of these patients.
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Affiliation(s)
- Jan Oldenburg
- Department of Clinical Cancer Research, University of Oslo, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
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Bradford TJ, Montie JE, Hafez KS. The Role of Imaging in the Surveillance of Urologic Malignancies. Urol Clin North Am 2006; 33:377-96. [PMID: 16829272 DOI: 10.1016/j.ucl.2006.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.
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Affiliation(s)
- Timothy J Bradford
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA
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Quek ML, Simma-Chiang V, Stein JP, Pinski J, Quinn DI, Skinner DG. Postchemotherapy residual masses in advanced seminoma: current management and outcomes. Expert Rev Anticancer Ther 2006; 5:869-74. [PMID: 16221056 DOI: 10.1586/14737140.5.5.869] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although pure testicular seminoma is most often confined to the testis, it can present with advanced-stage bulky retroperitoneal metastases in nearly a quarter of cases. While highly treatable with cisplatin-based chemotherapy, up to 80% of patients with advanced disease are found to have a radiographically detectable residual mass after chemotherapy. The management of these postchemotherapy residual masses remains controversial. Surgical resection is technically challenging due to a desmoplastic reaction resulting from seminoma treatment and regression. In addition, these residual masses often demonstrate a protracted period of regression that can span several months to years. Surveillance protocols, therefore, may be appropriate for most patients. Several retrospective studies have supported surgical resection only for discrete, well-delineated masses over 3 cm in size. Despite the highly radiosensitive nature of seminoma, radiation therapy in this setting has not been shown to provide significant benefit, and may limit the tolerability of subsequent salvage chemotherapy. The incorporation of noninvasive imaging modalities, such as positron emission tomography, into the management algorithm may better delineate the presence of viable residual tumor and thus allow better risk stratification.
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Affiliation(s)
- Marcus L Quek
- Department of Urology, Loyola University Stritch School of Medicine, IL 60153, USA.
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Abstract
Among germ cell tumours, seminomas hold a particular status related to their radio-sensitivity. Although radiotherapy remains the best treatment for Localized tumours of stage 1, in some cases, surveillance or chemotherapy may presently be considered as alternative therapies. Due to Long-term radiotherapy-related adverse effects, in particular the risk of second non-germ malignancies or cardiac morbidity, both dose and irradiation field are reduced in case of lymphatic retroperitoneal extension. Chemotherapy is the preferential treatment in more advanced stages, either with retroperitoneal bulky disease or with metastatic extension. Its efficacy allows Limiting surgical indications on residual masses, relying partly on the follow-up data of positron emission transaxial tomography assessment.
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Affiliation(s)
- A Houlgatte
- Clinique urologique, hôpital d'instruction des Armées du Val de Grâce, 74, boulevard de Port-Royal, 75005 Paris, France.
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40
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Becherer A, De Santis M, Karanikas G, Szabó M, Bokemeyer C, Dohmen BM, Pont J, Dudczak R, Dittrich C, Kletter K. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol 2005; 54:284-8. [PMID: 15837411 DOI: 10.1016/j.ejrad.2004.07.012] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2004] [Revised: 07/16/2004] [Accepted: 07/20/2004] [Indexed: 11/19/2022]
Abstract
AIM In advanced seminoma the management of residuals after completion of chemotherapy is controversial. Some centres routinely perform surgery for lesions > or =3 cm diameter, others recommend surgery solely if the residual fail to shrink or show even growth. This study prospectively investigates whether FDG PET can improve the prediction of viable tumour in post-chemotherapy seminoma residuals. MATERIALS AND METHODS After an expansion of a previous study population, 54 patients from eight centres with metastatic seminoma and a CT-documented mass after chemotherapy were included in the study. Six patients were excluded from evaluation because of protocol violations. After PET, the patients underwent either surgery or were followed clinically. On follow-up the lesions were considered to be non-viable when there was unequivocal shrinking, or when the lesion remained morphologically stable for at least 24 months. Any lesion growth was assumed to be malignant. PET results were compared to CT discrimination (< or > or =3 cm) of the residual masses. RESULTS Fifty-two PET scans were evaluable. After adequate chemotherapy, there were 74 CT-documented residual masses ranging in size from 1 to 11 cm (median, 2.2 cm). Their dignities were confirmed histologically in 13 lesions, or by follow-up CT in 61 lesions. Four of forty-seven lesions <3 cm and 11/27 lesions > or =3 cm were viable. PET was true positive in one lesion <3 cm and in 11 lesions > or =3 cm, false negative in three lesions <3 cm, and true negative in 59 lesions (43 lesions <3 cm). No PET scan was false positive. In detecting viability the sensitivity and specificity was 73% (95% CI, 44-88), and 73% (59-83), respectively, for CT (< or > or =3 cm); and 80% (51-95), and 100% (93-100), respectively, for PET (specificity, P < 0.001). CONCLUSION In post-chemotherapy seminoma residuals, a positive PET is highly predictive for the presence of viable tumour. The specificity of PET is significantly higher than that of CT when using a > or =3 cm cut-off. A negative PET scan is excellent for the exclusion of disease in lesions > or =3 cm, with a somewhat higher sensitivity than CT (n.s.). PET can contribute to the management of residual seminoma lesions, especially in terms of avoiding unnecessary additional treatment for patients with lesions > or =3 cm.
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Affiliation(s)
- Alexander Becherer
- Department of Nuclear Medicine, Ludwig Boltzmann Institute for Nuclear Medicine, University of Vienna, Währinger Gürtel 18-20, Vienna A-1090, Austria.
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41
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Albers P, Weissbach L, Krege S, Kliesch S, Hartmann M, Heidenreich A, Walz P, Kuczyk M, Fimmers R. Prediction of Necrosis After Chemotherapy of Advanced Germ Cell Tumors: Results of a Prospective Multicenter Trial of the German Testicular Cancer Study Group. J Urol 2004; 171:1835-8. [PMID: 15076288 DOI: 10.1097/01.ju.0000119121.36427.09] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We evaluated the prognostic parameters of necrotic residual tumors after chemotherapy of advanced germ cell tumors to improve on the current indications for surgery. MATERIALS AND METHODS Between January 1996 and January 2000, in 8 centers of the German Testicular Cancer Study Group, preoperative parameters were assessed to predict necrosis in the residual tumors of 261 patients with retroperitoneal residual tumor resection after first (92%) and second line (8%) chemotherapy. RESULTS Of 232 evaluable patients 39 had pure seminoma and 5 had viable cancer (1 with seminoma) in the residual tumor. Of the remaining 193 patients with nonseminoma 35% had necrosis, 34% teratoma and 31% had viable carcinoma in the residual tumor. After multivariate analysis and exclusion of patients with seminoma, the 3 parameters independently predictive of necrosis were alpha-fetoprotein before chemotherapy less than 20 ng/ml, and tumor volume before and after chemotherapy. A mathematical model to predict necrosis yielded a test accuracy of 75%, a sensitivity to predict necrosis of 52% and a specificity of 87%. CONCLUSIONS Patients with pure seminoma should not undergo residual tumor resection because 97% of patients who received adequate chemotherapy were found to have no residual seminoma. In cases of nonseminoma alpha-fetoprotein values before chemotherapy less than 20 ng/ml and a high percentage of shrinkage during chemotherapy reliably predicted only 19% of cases of necrosis. Therefore, this model is clinically irrelevant and patients with minimal residual disease should undergo surgery. New methods are necessary to improve the preoperative selection of patients after chemotherapy.
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Affiliation(s)
- Peter Albers
- Department of Urology, Bonn University, Germany.
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42
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De Santis M, Becherer A, Bokemeyer C, Stoiber F, Oechsle K, Sellner F, Lang A, Kletter K, Dohmen BM, Dittrich C, Pont J. 2-18fluoro-deoxy-D-glucose Positron Emission Tomography Is a Reliable Predictor for Viable Tumor in Postchemotherapy Seminoma: An Update of the Prospective Multicentric SEMPET Trial. J Clin Oncol 2004; 22:1034-9. [PMID: 15020605 DOI: 10.1200/jco.2004.07.188] [Citation(s) in RCA: 250] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To define the clinical value of 2-18fluoro-deoxy-D-glucose positron emission tomography (FDG PET) as a predictor for viable residual tumor in postchemotherapy seminoma residuals in a prospective multicentric trial. Patients and Methods FDG PET studies in patients with metastatic pure seminoma who had radiographically defined postchemotherapy residual masses were correlated with either the histology of the resected lesion or the clinical outcome documented by computer tomography (CT), tumor markers, and/or physical examination during follow-up. The size of the residual lesions on CT, either > 3 cm or ≤ 3 cm, was correlated with the presence or absence of viable residual tumor. Results Fifty-six FDG PET scans of 51 patients were assessable. All 19 cases with residual lesions > 3 cm and 35 (95%) of 37 with residual lesions ≤ 3 cm were correctly predicted by FDG PET. The specificity, sensitivity, positive predictive value, and negative predictive value of FDG PET were 100% (95% CI, 92% to 100%), 80% (95% CI, 44% to 95%), 100%, and 96%, respectively, versus 74% (95% CI, 58% to 85%), 70% (95% CI, 34% to 90%), 37%, and 92%, respectively, for CT discrimination of the residual tumor by size (> 3 cm/≤ 3 cm). Conclusion This investigation confirms that FDG PET is the best predictor of viable residual tumor in postchemotherapy seminoma residuals and should be used as a standard tool for clinical decision making in this patient group.
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Affiliation(s)
- Maria De Santis
- Department of Medical Oncology, Kaiser Franz Josef Spital, Kundratstrasse 3, A-1100 Wien, Austria
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