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Zhang H, Wen N, Gong X, Li X. Application of triboelectric nanogenerator (TENG) in cancer prevention and adjuvant therapy. Colloids Surf B Biointerfaces 2024; 242:114078. [PMID: 39018914 DOI: 10.1016/j.colsurfb.2024.114078] [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: 04/10/2024] [Revised: 06/15/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
Cancer is a malignant tumor that kills about 940,000 people worldwide each year. In addition, about 30-77 % of cancer patients will experience cancer metastasis and recurrence, which can increase the cancer mortality rate without prompt treatment. According to the US Food and Drug Administration, wearable devices can detect several physiological indicators of patients to reflect their health status and adjuvant cancer treatment. Based on the triboelectric effect and electrostatic induction phenomenon, triboelectric nanopower generation (TENG) technology can convert mechanical energy into electricity and drive small electronic devices. This article reviewed the research status of TENG in the areas of cancer prevention and adjuvant therapy. TENG can be used for cancer prevention with advanced sensors. At the same time, electrical stimulation generated by TENG can also be used to help inhibit the growth of cancer cells to reduce the proliferation, recurrence, and metastasis of cancer cells. This review will promote the practical application of TENG in healthcare and provide clean and sustainable energy solutions for wearable bioelectronic systems.
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Affiliation(s)
- Haohao Zhang
- Nanjing Institute of Technology, Jiangning District, Nanjing City, Jiangsu Province 211167, China
| | - Ning Wen
- National Engineering Research Center for Colloidal Materials, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Xiaoran Gong
- Nanjing Institute of Technology, Jiangning District, Nanjing City, Jiangsu Province 211167, China
| | - Xue Li
- Nanjing Institute of Technology, Jiangning District, Nanjing City, Jiangsu Province 211167, China.
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Auskalnis S, Janciauskiene R, Rimsaite U, Alksnyte A, Ugenskiene R. Synchronous Seminoma of Testis and Renal Cell Carcinoma: A Rare Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1553. [PMID: 39336594 PMCID: PMC11434273 DOI: 10.3390/medicina60091553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 09/18/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Seminoma is the most common solid malignant tumour in young men. Clear-cell kidney carcinoma is the most common malignancy of the genitourinary tract. However, the synchronous occurrence of both of these tumours is rare. Case presentation: We present the case of a 36-year-old patient who presented to a medical facility at the end of 2019 with an enlarged right testicle. A unilateral orchofuniculectomy was performed, and a mass measuring 30 cm was removed. During histological examination, testicular seminoma pT2, R0, was diagnosed. An abdominal computed tomography (CT) scan showed a 6.4 cm × 6.8 cm × 6.7 cm tumour in the right kidney and a metastatic-like lesion in the right adrenal gland. A right nephrectomy and an adrenalectomy and paraaortic and paracaval lymphadenectomies were performed. A histological evaluation confirmed the presence of clear-cell renal carcinoma pT2aR0 G2, adrenal hyperplasia, and seminoma metastases in the removed lymph node. Chemotherapy with a Bleomycin, Etoposide, and Cisplatin (BEP) regimen was carried out. Three years after the last cycle of chemotherapy, a follow-up CT scan showed metastases in the left kidney, the right ischium, and the right lung. A well-differentiated clear-cell carcinoma G1 of the left kidney and metastasis of clear-cell carcinoma G2 in the right ischium were confirmed after the biopsy, and no tumour lesions were found in the lung tissue specimen. Treatment with targeted therapy with Sunitinib was started because the risk was favourable according to the Heng criteria. Genetic testing was performed, and the following genes were analysed: VHL, BAP1, CHEK2, FH, MET, MUTYH, APC, and STK11. The testing did not reveal any pathogenic or potentially pathogenic mutations or sequence changes of unknown clinical significance in the genes analysed. Conclusions: According to the authors, the occurrence of synchronous primary tumours is linked to one's genetic predisposition. DNA sequencing of tumour tissue could provide more information on the corresponding aetiopathogenesis.
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Affiliation(s)
- Stasys Auskalnis
- Department of Urology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rasa Janciauskiene
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Urte Rimsaite
- Department of Oncology and Hematology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Aurelija Alksnyte
- Department of Urology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rasa Ugenskiene
- Department of Genetics and Molecular Medicine, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Reiter O, Voss V, Fluss R, Boyce L, DeFazio J, Halpern A, Marghoob A. Skin cancer risk among testicular germ-cell cancer survivors: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2022; 36:1025-1033. [PMID: 35034398 PMCID: PMC11137437 DOI: 10.1111/jdv.17932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Testicular germ-cell tumours (TGCT) are the most common cancer among young adult men. Previous studies suggested TGCT survivors have an increased risk for skin cancer. The goal of this study was to systematically review the literature and evidence regarding skin cancer risk among TGCT survivors compared with the general population. PubMed, EMBASE, Web of Science, Cochrane Databases and reference lists were included in the search. A systematic review of all comparative studies with more than 10 TGCT survivors reporting on skin cancer incidence was performed. A meta-analysis of the Standardized Incidence Rate (SIR) was calculated by pooling study-specific log-transformed estimates using the random-effects model. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. Nineteen studies that reported on 147 935 TGCT survivors were included. Pooled SIR for skin cancer and for melanoma incidence among TGCT survivors were 1.93 (95% CI 1.62-2.29, P < 0.0001) and 1.81 (95% CI 1.57-2.08, P < 0.0001), respectively. In conclusion, compared to the general population, TGCT survivors have an increased risk for developing skin cancer and melanoma. Additional long-term studies that include TGCT survivors, additional risk factors and all subtypes of skin cancer are required.
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Affiliation(s)
- O. Reiter
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - V.B. Voss
- Department of Dermatology, Stony Brook University, Stony Brook, NY, USA
| | - R. Fluss
- Biostatistics Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - L.M. Boyce
- MSK Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J.L. DeFazio
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A.C. Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A.A. Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Ottaviano M, Giunta EF, Rescigno P, Pereira Mestre R, Marandino L, Tortora M, Riccio V, Parola S, Casula M, Paliogiannis P, Cossu A, Vogl UM, Bosso D, Rosanova M, Mazzola B, Daniele B, Palmieri G, Palmieri G. The Enigmatic Role of TP53 in Germ Cell Tumours: Are We Missing Something? Int J Mol Sci 2021; 22:7160. [PMID: 34281219 PMCID: PMC8267694 DOI: 10.3390/ijms22137160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/24/2022] Open
Abstract
The cure rate of germ cell tumours (GCTs) has significantly increased from the late 1970s since the introduction of cisplatin-based therapy, which to date remains the milestone for GCTs treatment. The exquisite cisplatin sensitivity has been mainly explained by the over-expression in GCTs of wild-type TP53 protein and the lack of TP53 somatic mutations; however, several other mechanisms seem to be involved, many of which remain still elusive. The findings about the role of TP53 in platinum-sensitivity and resistance, as well as the reported evidence of second cancers (SCs) in GCT patients treated only with surgery, suggesting a spectrum of cancer predisposing syndromes, highlight the need for a deepened understanding of the role of TP53 in GCTs. In the following report we explore the complex role of TP53 in GCTs cisplatin-sensitivity and resistance mechanisms, passing through several recent genomic studies, as well as its role in GCT patients with SCs, going through our experience of Center of reference for both GCTs and cancer predisposing syndromes.
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Affiliation(s)
- Margaret Ottaviano
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Emilio Francesco Giunta
- Oncology Unit, Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, 80131 Naples, Italy;
| | - Pasquale Rescigno
- Interdisciplinary Group for Translational Research and Clinical Trials, Urological Cancers (GIRT-Uro), Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10160 Turin, Italy;
| | - Ricardo Pereira Mestre
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Laura Marandino
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Marianna Tortora
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
| | - Vittorio Riccio
- Department of Clinical Medicine and Surgery, Università degli studi di Napoli Federico II, 80131 Naples, Italy; (V.R.); (S.P.)
| | - Sara Parola
- Department of Clinical Medicine and Surgery, Università degli studi di Napoli Federico II, 80131 Naples, Italy; (V.R.); (S.P.)
| | - Milena Casula
- Institute of Genetics and Biomedical Research (IRGB), National Research Council (CNR), 07100 Sassari, Italy; (M.C.); (G.P.)
| | - Panagiotis Paliogiannis
- Departments of Biomedical Sciences and Medical, Surgical, Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.C.)
| | - Antonio Cossu
- Departments of Biomedical Sciences and Medical, Surgical, Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.C.)
| | - Ursula Maria Vogl
- IOSI (Oncology Institute of Southern Switzerland), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (R.P.M.); (L.M.); (U.M.V.)
| | - Davide Bosso
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
| | - Mario Rosanova
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
| | - Brunello Mazzola
- Department of Urology, Ente Ospedaliero Cantonale (EOC), 6600 Locarno, Switzerland;
| | - Bruno Daniele
- Oncology Unit, Ospedale del Mare, 80147 Naples, Italy; (D.B.); (M.R.); (B.D.)
| | - Giuseppe Palmieri
- Institute of Genetics and Biomedical Research (IRGB), National Research Council (CNR), 07100 Sassari, Italy; (M.C.); (G.P.)
- Departments of Biomedical Sciences and Medical, Surgical, Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.C.)
| | - Giovannella Palmieri
- CRCTR Coordinating Rare Tumors Reference Center of Campania Region, 80131 Naples, Italy; (M.T.); (G.P.)
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Pehalova L, Krejci D, Halamkova J, Smardova L, Snajdrova L, Dusek L. Significant current epidemiological trend: Haematological malignancies as subsequent primary tumours in cancer patients. Cancer Epidemiol 2021; 72:101929. [PMID: 33819838 DOI: 10.1016/j.canep.2021.101929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Numbers of patients who develop subsequent primary tumours have markedly increased recently. This study aimed to carry out a comprehensive analysis documenting the risk of incidence of subsequent haematological malignancies. METHODS The Czech National Cancer Registry was the main data source, containing records of 126,822 haematological malignancies diagnosed in the period 1977-2016. Subsequent haematological malignancies were identified according to IACR rules. Joinpoint regression was employed to assess the time trends. The risk of development of subsequent haematological malignancy was evaluated by the standardised incidence ratio. The Kaplan-Meier curves were used to assess the differences in survival. RESULTS Age-standardised incidence of subsequent haematological malignancies increased from 0.5 in 1977 to 9.1 in 2016. In 1992, there was a significant change in the trend: a sharp increase by 7.7 % annually was revealed thereafter. The risk of development of a haematological malignancy was approximately 1.5 times higher in persons with history of any cancer than in the general Czech population. Patients with haematological malignancies - mainly myelodysplastic syndromes, polycythaemia vera and non-Hodgkin lymphoma - were shown to be at the highest risk of developing a subsequent haematological malignancy. While the median survival following a first haematological malignancy was 2.3 years, it was only 1.1 years for subsequent haematological malignancies (p < 0.001). CONCLUSIONS Our study identified the highest-risk diagnoses in terms of development of subsequent haematological malignancy. The results might be useful to set up correctly follow-up procedures from which cancer patients could benefit.
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Affiliation(s)
- Lucie Pehalova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
| | - Denisa Krejci
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Jana Halamkova
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Medical Ethics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lenka Smardova
- Department of Internal Medicine, Haematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Lenka Snajdrova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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Contemporary trends in management of stage 1 seminoma. Urol Oncol 2021; 39:240.e1-240.e8. [PMID: 33602622 DOI: 10.1016/j.urolonc.2020.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Surveillance is now the preferred treatment strategy for patients with stage 1A/1B seminoma as reflected by the National Comprehensive Cancer Network guidelines. In this study, we aimed to describe trends in adjuvant management strategy for stage 1A/B seminoma from 2004 to 2016 using the National Cancer Database. MATERIALS AND METHODS The database was queried for patients diagnosed with stage 1A/1B seminoma between 2004 and 2016. Staging was determined using the American Joint Committee on Cancer guidelines. Surveillance was defined as no treatment with chemotherapy or radiation within 60 days of diagnosis. Proportions of cancer patients utilizing surveillance, radiation, and single-agent chemotherapy were summarized annually. Kaplan-Meier survival analysis was used to compare overall survival between groups. RESULTS 8,686 patients with stage 1A/1B seminoma met inclusion criteria over the course of the study period. Overall, 3,004 (34.6%) patients began adjuvant chemotherapy or radiation within 60 days. Utilization of surveillance increased from 39.8% in 2004 to 86.8% in 2016 while utilization of radiation decreased from 59.7% to 4.6%. High-volume centers adopted surveillance earlier than low-volume centers. CONCLUSION This study describes trends in utilization of surveillance, chemotherapy, and radiotherapy for stage 1A/1B seminoma over 12 years. A major shift from utilization of adjuvant treatment to surveillance in patients with stage 1A/B seminoma is observed in this large national cancer database; a minority of patients now receive adjuvant treatment and risk-related toxicities. Survival analysis reveals similar survival at a median 5-year follow-up. The results provide insight into the time needed for clinical practice to adopt the preferred approach of surveillance over the time period studied.
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Ykema BLM, Bisseling TM, Spaander MCW, Moons LMG, van der Biessen-van Beek D, Saveur L, Kerst M, Mulder SF, de Wit R, Zweers D, Meijer GA, Beijnen JH, Lansdorp-Vogelaar I, van Leeuwen FE, Snaebjornsson P, van Leerdam ME. Diagnostic yield of colonoscopy surveillance in testicular cancer survivors treated with platinum-based chemotherapy: study protocol of a prospective cross-sectional cohort study. BMC Gastroenterol 2021; 21:67. [PMID: 33579196 PMCID: PMC7881638 DOI: 10.1186/s12876-021-01639-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background Testicular cancer (TC) survivors have an increased risk of various second primary malignancies. A recent cohort study detected an increased risk of colorectal cancer (CRC) in TC survivors treated with platinum-based chemotherapy with a hazard ratio of 3.9. CRC risk increased with higher cisplatin-dose. We know that colonoscopy surveillance in high-risk populations results in reduced incidence and mortality of CRC. TC survivors treated with platinum-based chemotherapy can potentially benefit from colonoscopy surveillance; however, to which extent is unknown. Furthermore, the pathogenesis of these secondary CRCs is unknown, and better insights into the carcinogenesis may affect surveillance decisions. Methods This prospective multicenter study will be performed in four Dutch hospitals. TC survivors are eligible if treated with ≥ 3 cycles of cisplatin before age 50. Colonoscopy will be performed ≥ 8 years after initial treatment (minimum and maximum ages at colonoscopy, 35 and 75 years, respectively). The primary aim of the study is the diagnostic yield of advanced neoplasia detected during colonoscopy. As secondary aim, we will evaluate the molecular profile of advanced colorectal neoplasia and will assess current platinum levels in blood and urine and correlate blood-platinum levels with prevalence of colorectal lesions. Furthermore, we will investigate effectiveness of fecal immunochemical testing (FIT) and burden of colonoscopy by two questionnaires. Demographic data, previous history, results of colonoscopy, hemoglobin level of FIT and results of molecular and platinum levels will be obtained. Yield of colonoscopy will be determined by detection rate of adenoma and serrated lesions, advanced adenoma detection rate and CRC detection rate. The MISCAN model will be used for cost-effectiveness analyses of CRC surveillance. With 234 participants undergoing colonoscopy, we can detect an absolute difference of 6% of advanced neoplasia with 80% power. Discussion TC survivors treated with cisplatin-based chemotherapy can benefit from CRC surveillance. Evaluation of the diagnostic performance and patient acceptance of CRC surveillance is of importance to develop surveillance recommendations. Insight into the carcinogenesis of cisplatin-related advanced colorectal lesions will contribute to CRC prevention in the increasing number of TC survivors. The results may also be important for the many other cancer survivors treated with platinum-based chemotherapy. Trial registration Clinical Trials: NCT04180033, November 27, 2019, https://clinicaltrials.gov/ct2/show/NCT04180033.
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Affiliation(s)
- Berbel L M Ykema
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Tanya M Bisseling
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Lisette Saveur
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Danielle Zweers
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerrit A Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jos H Beijnen
- Department of Pharmacy and Pharmacology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Origin of Subsequent Malignant Neoplasms in Patients with History of Testicular Germ Cell Tumor. Cancers (Basel) 2020; 12:cancers12123755. [PMID: 33327406 PMCID: PMC7764868 DOI: 10.3390/cancers12123755] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/05/2020] [Accepted: 12/10/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Although testicular germ cell tumor (TGCT) carries a high cure rate, some patients still die from it. We investigated the genetic landscape and cellular origins of cancers that develop later in life after treatment for TGCT and found evidence that a common progenitor cell might be responsible for both. This study shows the possible importance of stem-like cells in the development of cancer. Abstract Although genetic changes may be pivotal in the origin of cancer, cellular context is paramount. This is particularly relevant in a progenitor germ cell tumor and its differentiated mature teratoma counterpart when it concerns tumor heterogeneity and cancer dormancy in subsequent second malignancies (subsequent malignant neoplasms (SMNs)). From our tumor registry database, we identified 655 testicular germ cell tumor (TGCT) patients who developed SMNs between January 1990 and September 2018. Of the 113 solid organ SMNs, 42 had sufficient tumor tissue available for fluorescence in situ hybridization (FISH) analysis of isochromosome 12p [i(12p)]. We identified seven additional patients for targeted DNA and RNA sequencing of teratomas and adjacent somatic transformation. Finally, we established cell lines from freshly resected post-chemotherapy teratomas and evaluated the cells for stemness expression by flow cytometry and by the formation of teratomas in a xenograft model. In our cohort, SMNs comprising non-germ cell tumors occurred about 18 years after a diagnosis of TGCT. Of the 42 SMNs examined, 5 (12%) contained i(12p) and 16 (38%) had 12p gain. When comparing a teratoma and adjacent somatic transformation, targeted DNA and RNA sequencing demonstrated high concordance. Studies of post-chemotherapy teratoma-derived cell lines revealed cancer-initiating cells expressing multipotency as well as early differentiation markers. For the first time, we demonstrated the prevalence of i(12p) in SMNs and the presence of progenitor cells embedded within mature teratomas after chemotherapy. Our findings suggest a progenitor stem-like cell of origin in SMN and TGCT and highlight the importance of cellular context in this disease.
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Larsen SKA, Agerbæk M, Jurik AG, Pedersen EM. Ten years of experience with MRI follow-up of testicular cancer stage I: a retrospective study and an MRI protocol with DWI. Acta Oncol 2020; 59:1374-1381. [PMID: 32684054 DOI: 10.1080/0284186x.2020.1794035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Patients with testicular cancer (TC) are mainly young and survival rates are high. MRI has several times been proposed to replace CT in follow-up of this patient group to reduce image-related radiation exposure. However, current evidence is scarce for the use of MRI in this context. AIMS First, to retrospectively evaluate the ability of MRI of the retroperitoneum and pelvis to detect relapse in patients with TC stage I. Second, to present a relevant MRI protocol of the retroperitoneum and pelvis with diffusion weighted imaging (DWI). MATERIAL AND METHODS A retrospective analysis of written radiology reports compared to clinical data from clinical practice from 2010 to 2018. The cohort consists of 2487 MRIs of the retroperitoneum and pelvis in 759 patients with TC stage I (524 seminoma (69.0%), 235 non-seminoma (31.0%)), including 102 patients (13.4%) with confirmed relapse. Confirmed relapse was defined when treatment was initiated for metastatic TC. RESULTS Ninety-five patients had a relapse in the MRI scan field during follow-up. MRI of the retroperitoneum and pelvis showed a high sensitivity of 93.8% and a high specificity of 97.4% for detecting TC relapse. The sensitivity for detecting relapse ≥10 mm in short axis lymph node diameter was 100%. The negative predictive value was 99.7%, the positive predictive value was 59.9% and the accuracy was 97.3%. CONCLUSIONS MRI of the retroperitoneum and pelvis constitutes a safe alternative to CT in follow-up of patients with TC stage I with both a high sensitivity and a high specificity. We present a robust MRI protocol with DWI and estimate that MRI follow-up of TC stage I can be easily implemented in most modern radiology departments. Registration: Conducted with permission from the Danish Data Protection Agency (1-16-02-323-16) and the Danish Health Authority.
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Affiliation(s)
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Milano MT, Dinh PC, Yang H, Zaid MA, Fossa SD, Feldman DR, Monahan PO, Travis LB, Fung C. Solid and Hematologic Neoplasms After Testicular Cancer: A US Population-Based Study of 24 900 Survivors. JNCI Cancer Spectr 2020; 4:pkaa017. [PMID: 32455335 PMCID: PMC7236780 DOI: 10.1093/jncics/pkaa017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/17/2019] [Accepted: 02/19/2020] [Indexed: 01/30/2023] Open
Abstract
Background No large US population-based study focusing on recent decades, to our knowledge, has comprehensively examined risks of second malignant solid and hematological neoplasms (solid-SMN and heme-SMN) after testicular cancer (TC), taking into account initial therapy and histological type. Methods Standardized incidence ratios (SIR) vs the general population and 95% confidence intervals (CI) for solid-SMN and heme-SMN were calculated for 24 900 TC survivors (TCS) reported to the National Cancer Institute’s Surveillance, Epidemiology, and End Results registries (1973–2014). All statistical tests were two-sided. Results The median age at TC diagnosis was 33 years. Initial management comprised chemotherapy (n = 6340), radiotherapy (n = 9058), or surgery alone (n = 8995). During 372 709 person-years of follow-up (mean = 15 years), 1625 TCS developed solid-SMN and 228 (107 lymphomas, 92 leukemias, 29 plasma cell dyscrasias) developed heme-SMN. Solid-SMN risk was increased 1.06-fold (95% CI = 1.01 to 1.12), with elevated risks following radiotherapy (SIR = 1.13, 95% CI = 1.06 to 1.21) and chemotherapy (SIR = 1.36, 95% CI = 1.12 to 1.41) but not surgery alone (SIR = 0.83, 95% CI = 0.75 to 0.92). Corresponding risks for seminoma were 1.13 (95% CI = 1.06 to 1.21), 1.28 (95% CI = 1.02 to 1.58), and 0.87 (95% CI = 0.74 to 1.01) and for nonseminoma were 1.05 (95% CI = 0.67 to 1.56), 1.25 (95% CI = 1.08 to 1.43), and 0.80 (95% CI = 0.70 to 0.92), respectively. Thirty-year cumulative incidences of solid-SMN after radiotherapy, chemotherapy, and surgery alone were 16.9% (95% CI = 15.7% to 18.1%), 10.1% (95% CI = 8.8% to 11.5%), and 8.8% (95% CI = 7.8% to 9.9%), respectively (P < .0001). Increased leukemia risks after chemotherapy (SIR = 2.68, 95% CI = 1.70 to 4.01) were driven by statistically significant sevenfold excesses of acute myeloid leukemia 1 to 10 years after TC diagnosis. Risks for lymphoma and plasma cell dyscrasias were not elevated. Conclusions We report statistically significant excesses of solid-SMN affecting 1 in 6 TCS 30 years after radiotherapy, and 2.7-fold risks of leukemias after chemotherapy, mostly acute myeloid leukemia. Efforts to minimize chemotherapy and radiotherapy exposures for TC should continue. TCS should be counseled about cancer prevention and screening.
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Affiliation(s)
- Michael T Milano
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Paul C Dinh
- Indiana University School of Medicine and Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Hongmei Yang
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Mohammad Abu Zaid
- Indiana University School of Medicine and Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | | | - Patrick O Monahan
- Indiana University School of Medicine and Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Lois B Travis
- Indiana University School of Medicine and Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Chunkit Fung
- University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
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Groot HJ, van Leeuwen FE, Lubberts S, Horenblas S, de Wit R, Witjes JA, Groenewegen G, Poortmans PM, Hulshof MCCM, Meijer OWM, de Jong IJ, van den Berg HA, Smilde TJ, Vanneste BGL, Aarts MJB, Jóźwiak K, van den Belt-Dusebout AW, Gietema JA, Schaapveld M. Platinum exposure and cause-specific mortality among patients with testicular cancer. Cancer 2019; 126:628-639. [PMID: 31730712 PMCID: PMC7004069 DOI: 10.1002/cncr.32538] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/06/2022]
Abstract
Background Although testicular cancer (TC) treatment has been associated with severe late morbidities, including second malignant neoplasms (SMNs) and ischemic heart disease (IHD), cause‐specific excess mortality has been rarely studied among patients treated in the platinum era. Methods In a large, multicenter cohort including 6042 patients with TC treated between 1976 and 2006, cause‐specific mortality was compared with general population mortality rates. Associations with treatment were assessed with proportional hazards analysis. Results With a median follow‐up of 17.6 years, 800 patients died; 40.3% of these patients died because of TC. The cumulative mortality was 9.6% (95% confidence interval [CI], 8.5%‐10.7%) 25 years after TC treatment. In comparison with general population mortality rates, patients with nonseminoma experienced 2.0 to 11.6 times elevated mortality from lung, stomach, pancreatic, rectal, and kidney cancers, soft‐tissue sarcomas, and leukemia; 1.9‐fold increased mortality (95% CI, 1.3‐2.8) from IHD; and 3.9‐fold increased mortality (95% CI, 1.5‐8.4) from pneumonia. Seminoma patients experienced 2.5 to 4.6 times increased mortality from stomach, pancreatic, bladder cancer and leukemia. Radiotherapy and chemotherapy were associated with 2.1 (95% CI, 1.8‐2.5) and 2.5 times higher SMN mortality (95% CI, 2.0‐3.1), respectively, in comparison with the general population. In a multivariable analysis, patients treated with platinum‐containing chemotherapy had a 2.5‐fold increased hazard ratio (HR; 95% CI, 1.8‐3.5) for SMN mortality in comparison with patients without platinum‐containing chemotherapy. The HR for SMN mortality increased 0.29 (95% CI, 0.19‐0.39) per 100 mg/m2 platinum dose administered (Ptrend < .001). IHD mortality was increased 2.1‐fold (95% CI, 1.5‐4.2) after platinum‐containing chemotherapy in comparison with patients without platinum exposure. Conclusions Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of SMN mortality. Platinum‐containing chemotherapy is associated with a dose‐dependent increase in the risk of cancer mortality among patients with testicular cancer. Patients with testicular cancer experience increased mortality from second malignancies as well as causes other than cancer, particularly ischemic heart diseases.
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Affiliation(s)
- Harmke J Groot
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Flora E van Leeuwen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Simon Horenblas
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Philip M Poortmans
- Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, the Netherlands.,Department of Radiation Oncology, Curie Institute, Paris, France
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, the Netherlands
| | - Otto W M Meijer
- Department of Radiation Oncology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Igle J de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Ben G L Vanneste
- Department of Radiotherapy, Maastro Clinic, Maastricht, the Netherlands
| | - Maureen J B Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Katarzyna Jóźwiak
- Department of Biostatistics, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | | | - Jourik A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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12
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Khadivi F, Razavi S, Hashemi F. Protective effects of zinc on rat sperm chromatin integrity involvement: DNA methylation, DNA fragmentation, ubiquitination and protamination after bleomycin etoposide and cis-platin treatment. Theriogenology 2019; 142:177-183. [PMID: 31600638 DOI: 10.1016/j.theriogenology.2019.09.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/29/2019] [Accepted: 09/24/2019] [Indexed: 01/11/2023]
Abstract
Testicular cancer is one of the most common malignancy in young men, chemotherapy induced damage in cancerous cells as well as healthy tissue, and we decided to investigate recovery effect of zinc (Zn) on chemotherapy-induced complications in rat chromatin integrity and testicular histomorphometry. The male rats (n = 40) were treated with BEP at appropriate dose levels of BEP (0.75, 7.5, and 1.5 mg/kg) for 9 weeks, with or without Zn; testicular histology, sperm DNA methylation, ubiquitination, DNA fragmentation and protamination were further assessed through immunofluorescence. BEP treatment significantly increased ubiquitination, and DNA fragmentation, considerably reducing global DNA methylation and protamination (P < 0.001), resulting in degenerative changes in testicular structure. Zn restored normal DNA methylation, protamination and structure of male gonads, maintained spermatogonial stem cells, and significantly reduced the mean percentage of ubiquitination and sperm DNA fragmentation as compared with BEP group (P < 0.001). We found that supplementation of Zn following chemotherapy can improve chromatin integrity, testicular organization and spermatogenesis.
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Affiliation(s)
- Farnaz Khadivi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Anatomical Sciences, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahnaz Razavi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Fatemeh Hashemi
- Department of Anatomical Sciences, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Contemporary Assessment of Survival Rates in Stage I Testicular Seminoma: A Population-Based Comparison Between Surveillance and Active Treatment After Orchiectomy. Clin Genitourin Cancer 2019; 17:e793-e801. [DOI: 10.1016/j.clgc.2019.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/19/2019] [Indexed: 11/17/2022]
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14
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Groot HJ, Lubberts S, de Wit R, Witjes JA, Kerst JM, de Jong IJ, Groenewegen G, van den Eertwegh AJ, Poortmans PM, Klümpen HJ, van den Berg HA, Smilde TJ, Vanneste BG, Aarts MJ, Incrocci L, van den Bergh AC, Jóźwiak K, van den Belt-Dusebout AW, Horenblas S, Gietema JA, van Leeuwen FE, Schaapveld M. Risk of Solid Cancer After Treatment of Testicular Germ Cell Cancer in the Platinum Era. J Clin Oncol 2018; 36:2504-2513. [DOI: 10.1200/jco.2017.77.4174] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose Testicular cancer (TC) treatment increases risk of subsequent malignant neoplasms (SMNs). It is unknown whether changes in TC treatment over time have affected SMN risk. Methods Solid SMN risk was evaluated in a multicenter cohort comprising 5,848 1-year survivors treated for TC before age 50 years between 1976 and 2007. SMN incidence was compared with cancer incidence in the general population. Treatment-specific risks were assessed using multivariable regression in a case-cohort design. Results After a median follow-up of 14.1 years, 350 solid SMNs were observed, translating into a 1.8-fold (95% CI, 1.6-2.0) increased risk compared with general population rates. Solid SMN risk was increased in patients with seminoma and those with nonseminoma (standardized incidence ratio, 1.52 and 2.21, respectively). Patients with nonseminoma experienced increased risk of SMNs of the thyroid, lung, stomach, pancreas, colon, and bladder and of melanoma and soft tissue sarcoma, whereas those with seminoma experienced increased risk of SMNs of the small intestine, pancreas, and urinary bladder. The 25-year cumulative incidence of solid SMNs was 10.3% (95% CI, 9.0% to 11.6%). In multivariable analysis, platinum-based chemotherapy was associated with increased risk of a solid SMN (hazard ratio [HR], 2.40; 95% CI, 1.58 to 3.62), colorectal SMN (HR, 3.85; 95% CI, 1.67 to 8.92), and noncolorectal GI SMN (HR, 5.00; 95% CI, 2.28 to 10.95). Receipt of platinum 400 to 499 and ≥ 500 mg/m2 increased solid SMN risk compared with surgery only (HR, 2.43; 95% CI, 1.40 to 4.23 and HR, 2.42; 95% CI, 1.50 to 3.90, respectively), whereas risk was not significantly increased with lower doses (HR, 1.75; 95% CI, 0.90 to 3.43). The HR of a GI SMN increased by 53% (95% CI, 26% to 80%) per 100 mg/m2 of platinum-containing chemotherapy. The HR of an infradiaphragmatic SMN increased by 8% per Gray of radiation dose administered (95% CI, 6% to 9%; P < .001). Conclusion Radiotherapy and platinum-containing chemotherapy are associated with increased solid SMN risk, specifically with GI SMNs.
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Affiliation(s)
- Harmke J. Groot
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Sjoukje Lubberts
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Ronald de Wit
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Johannes A. Witjes
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Jan Martijn Kerst
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Igle J. de Jong
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Gerard Groenewegen
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Alfons J.M. van den Eertwegh
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Philip M. Poortmans
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Heinz-Josef Klümpen
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Hetty A. van den Berg
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Tineke J. Smilde
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Ben G.L. Vanneste
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Maureen J. Aarts
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Luca Incrocci
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Alfons C.M. van den Bergh
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Katarzyna Jóźwiak
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Alexandra W. van den Belt-Dusebout
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Simon Horenblas
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Jourik A. Gietema
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Flora E. van Leeuwen
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
| | - Michael Schaapveld
- Harmke J. Groot, Jan Martijn Kerst, Katarzyna Jóźwiak, Alexandra W. van den Belt-Dusebout, Simon Horenblas, Flora E. van Leeuwen, and Michael Schaapveld, Netherlands Cancer Institute; Alfons J.M. van den Eertwegh, Vrije Universiteit Medical Center; Heinz-Josef Klümpen, Academic Medical Center, Amsterdam; Sjoukje Lubberts, Igle J. de Jong, Alfons C.M. van den Bergh, and Jourik A. Gietema, University Medical Center Groningen, University of Groningen, Groningen; Ronald de Wit and Luca Incrocci, Erasmus
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Radiotherapy in testicular germ cell tumours - a literature review. Contemp Oncol (Pozn) 2017; 21:203-208. [PMID: 29180926 PMCID: PMC5701577 DOI: 10.5114/wo.2017.69592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/12/2017] [Indexed: 11/17/2022] Open
Abstract
Testicular germ cell tumours (GCT) represent about 1-2% of malignant in men. The essential therapeutic option for early-stage GCT is radical orchiectomy (RO), except in situations that require immediate chemotherapy in patients with a massive dissemination and unequivocally elevated levels of tumour markers. Postoperative radiotherapy (PORT) in patients with testicular seminoma in Clinical Stage I (CS I) is one of the treatment options next to active surveillance (AS) and chemotherapy (CHTH). Regardless of the procedure, five-year survival in this group of patients ranges between 97% and 100%. In the article, we present the literature review pertinent to therapeutic options, with a focus on radiotherapy. We have searched MEDLINE (PubMed) for all studies on patients with GCT treated with radiation therapy during the last 20 years, and the current therapeutic recommendations. We used the following keywords: germ cell tumours, testis, seminoma, non-seminoma, radiotherapy, outcome.
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Hauptmann M, Børge Johannesen T, Gilbert ES, Stovall M, van Leeuwen FE, Rajaraman P, Smith SA, Weathers RE, Aleman BMP, Andersson M, Curtis RE, Dores GM, Fraumeni Jr JF, Hall P, Holowaty EJ, Joensuu H, Kaijser M, Kleinerman RA, Langmark F, Lynch CF, Pukkala E, Storm HH, Vaalavirta L, van den Belt-Dusebout AW, Morton LM, Fossa SD, Travis LB. Increased pancreatic cancer risk following radiotherapy for testicular cancer. Br J Cancer 2016; 115:901-8. [PMID: 27599043 PMCID: PMC5046216 DOI: 10.1038/bjc.2016.272] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/18/2016] [Accepted: 08/05/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pancreatic cancer risk is elevated among testicular cancer (TC) survivors. However, the roles of specific treatments are unclear. METHODS Among 23 982 5-year TC survivors diagnosed during 1947-1991, doses from radiotherapy to the pancreas were estimated for 80 pancreatic cancer patients and 145 matched controls. Chemotherapy details were recorded. Logistic regression was used to estimate odds ratios (ORs). RESULTS Cumulative incidence of second primary pancreatic cancer was 1.1% at 30 years after TC diagnosis. Radiotherapy (72 (90%) cases and 115 (80%) controls) was associated with a 2.9-fold (95% confidence interval (CI) 1.0-7.8) increased risk. The OR increased linearly by 0.12 per Gy to the pancreas (P-trend<0.001), with an OR of 4.6 (95% CI 1.9-11.0) for ⩾25 Gy vs <25 Gy. Radiation-related risks remained elevated ⩾20 years after TC diagnosis (P=0.020). The risk increased with the number of cycles of chemotherapy with alkylating or platinum agents (P=0.057), although only one case was exposed to platinum. CONCLUSIONS A dose-response relationship exists between radiation to the pancreas and subsequent cancer risk, and persists for over 20 years. These excesses, although small, should be considered when radiotherapy with exposure to the pancreas is considered for newly diagnosed patients. Additional data are needed on the role of chemotherapy.
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Affiliation(s)
- Michael Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - Ethel S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Marilyn Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Flora E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Preetha Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Susan A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rita E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Berthe M P Aleman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michael Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rochelle E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Graça M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Joseph F Fraumeni Jr
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eric J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Heikki Joensuu
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Magnus Kaijser
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ruth A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | | | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Leila Vaalavirta
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Sophie D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Lois B Travis
- Melvin and Bren Simon Cancer Center, Indianapolis University School of Medicine, Indianapolis, IN, USA
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Segundo primario en un paciente con antecedente de tumor germinal seminomatoso de testículo. Reporte del caso y revisión de la literatura. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Correa Ochoa JJ, Velásquez Ossa D, Lopera Toro AR, Martínez González CH, Yepes Pérez A. Guía colombiana de cáncer de testículo. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rizzi S, Thinggaard M, Engholm G, Christensen N, Johannesen TB, Vaupel JW, Lindahl-Jacobsen R. Comparison of non-parametric methods for ungrouping coarsely aggregated data. BMC Med Res Methodol 2016; 16:59. [PMID: 27216531 PMCID: PMC4877978 DOI: 10.1186/s12874-016-0157-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/08/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Histograms are a common tool to estimate densities non-parametrically. They are extensively encountered in health sciences to summarize data in a compact format. Examples are age-specific distributions of death or onset of diseases grouped in 5-years age classes with an open-ended age group at the highest ages. When histogram intervals are too coarse, information is lost and comparison between histograms with different boundaries is arduous. In these cases it is useful to estimate detailed distributions from grouped data. METHODS From an extensive literature search we identify five methods for ungrouping count data. We compare the performance of two spline interpolation methods, two kernel density estimators and a penalized composite link model first via a simulation study and then with empirical data obtained from the NORDCAN Database. All methods analyzed can be used to estimate differently shaped distributions; can handle unequal interval length; and allow stretches of 0 counts. RESULTS The methods show similar performance when the grouping scheme is relatively narrow, i.e. 5-years age classes. With coarser age intervals, i.e. in the presence of open-ended age groups, the penalized composite link model performs the best. CONCLUSION We give an overview and test different methods to estimate detailed distributions from grouped count data. Health researchers can benefit from these versatile methods, which are ready for use in the statistical software R. We recommend using the penalized composite link model when data are grouped in wide age classes.
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Affiliation(s)
- Silvia Rizzi
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
| | - Mikael Thinggaard
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
| | - Gerda Engholm
- />Danish Cancer Society, Strandboulevarden 49, Copenhagen, 2100 Denmark
| | - Niels Christensen
- />Danish Cancer Society, Strandboulevarden 49, Copenhagen, 2100 Denmark
| | | | - James W. Vaupel
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Max Planck Institute for Demographic Research, Konrad-Zuse Str. 1, Rostock, 18057 Germany
| | - Rune Lindahl-Jacobsen
- />Max Planck Odense Center on the Biodemography of Aging, J.B. Winsløws Vej 9, Odense, 5000 Denmark
- />Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, J.B. Winsløws Vej 9, Odense, 5000 Denmark
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Bagheri-Sereshki N, Hales BF, Robaire B. The Effects of Chemotherapeutic Agents, Bleomycin, Etoposide, and Cisplatin, on Chromatin Remodeling in Male Rat Germ Cells. Biol Reprod 2016; 94:81. [PMID: 26911428 PMCID: PMC4861167 DOI: 10.1095/biolreprod.115.137802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/03/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022] Open
Abstract
The coadministration of bleomycin, etoposide, and cisplatin (BEP) has increased the survival rate of testicular cancer patients to over 90%. Previous studies have demonstrated that BEP induces germ cell damage during the final stages of spermatogenesis, when major chromatin remodeling occurs. Chromatin remodeling permits histone-protamine exchange, resulting in sperm head chromatin compaction. This process involves different epigenetic modifications of the core histones. The objective of these studies was to investigate the effects of BEP on epigenetic modifications to histones involved in chromatin remodeling. Brown Norway rats were treated with BEP, and their testes were removed to isolate pachytene spermatocytes and round spermatids by unit gravity sedimentation. Western blot analyses were conducted on extracted proteins to detect the expression of key modified histones. In a second cohort testes were prepared for immunohistochemical analysis. The stage-specific expression of each modified histone mark in rat spermatogenesis suggests the involvement of these modifications in chromatin remodeling. BEP treatment significantly increased expression of H3K9m and decreased that of tH2B (or Hist1h2ba) in pachytene spermatocytes, suggesting that nucleosomes were not destabilized to allow for transcription of genes involved in chromatin remodeling. Moreover, BEP treatment altered the expression of H4K8ac in round and elongating spermatids, suggesting that histone eviction was compromised, leading to a looser chromatin structure in mature spermatozoa. Less-compacted sperm chromatin, with alterations to the sperm epigenome, may have an adverse effect on male fertility.
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Affiliation(s)
- Negar Bagheri-Sereshki
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
| | - Barbara F Hales
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
| | - Bernard Robaire
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
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Kvammen Ø, Myklebust TÅ, Solberg A, Møller B, Klepp OH, Fosså SD, Tandstad T. Long-term Relative Survival after Diagnosis of Testicular Germ Cell Tumor. Cancer Epidemiol Biomarkers Prev 2016; 25:773-9. [PMID: 26908435 DOI: 10.1158/1055-9965.epi-15-1153] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/02/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Long-term relative survival (RS) data for testicular germ cell tumor (TGCT) patients are scarce. We aimed to analyze long-term RS among TGCT patients diagnosed in Norway, between 1953 and 2012. METHODS Data sources were the Cancer Registry of Norway and the Norwegian Cause of Death Registry. TGCT patients diagnosed during 1953 to 2012 were classified by time of diagnosis, histology, age, and disease extent at diagnosis. Estimates for RS were obtained, and a test comparing overall RS was performed. Corresponding data were obtained for men diagnosed with localized malignant melanoma before age 50. RESULTS A total of 8,736 TGCT patients were included. RS generally continued to decline with increasing follow-up time, particularly beyond 15 to 30 years, unlike in localized malignant melanoma. Although RS was generally higher for seminomas, the continuing decline was more pronounced than for nonseminomas, even when diagnosed with localized disease. TGCT patients diagnosed before 1980 or after age 40 had lower RS. CONCLUSIONS Although TGCT RS has improved in recent decades, it continues to decline even beyond 30 years of follow-up, regardless of disease extent at diagnosis. The main cause is probably treatment-induced late effects, particularly affecting seminoma patients. The continued use of adjuvant radiotherapy in seminomas until year 2000 is suspected as a culprit. IMPACT Long-term TGCT survivors should be closely monitored for the development of late comorbidity. The challenge is to reduce negative consequences of previous and current TGCT treatment on RS while maintaining the excellent cure rates. Further research on causes of long-term morbidity and mortality among TGCT survivors is warranted. Cancer Epidemiol Biomarkers Prev; 25(5); 773-9. ©2016 AACR.
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Affiliation(s)
- Øivind Kvammen
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway.
| | - Tor Å Myklebust
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | - Arne Solberg
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Bjørn Møller
- Department of Registration, Cancer Registry of Norway, Oslo, Norway
| | | | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
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22
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Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System. Clin Genitourin Cancer 2016; 14:438-443. [PMID: 26794393 DOI: 10.1016/j.clgc.2015.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/10/2015] [Accepted: 12/16/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. MATERIALS AND METHODS A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. RESULTS The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P < .001 for 2006-2011 vs. 2001-2005; relative rate ratio, 19.3; 95% confidence interval [CI], 8.04-46.13). A later year of diagnosis was not significantly associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively. CONCLUSION The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population.
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23
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Hauptmann M, Fossa SD, Stovall M, van Leeuwen FE, Johannesen TB, Rajaraman P, Gilbert ES, Smith SA, Weathers RE, Aleman BMP, Andersson M, Curtis RE, Dores GM, Fraumeni JF, Hall P, Holowaty EJ, Joensuu H, Kaijser M, Kleinerman RA, Langmark F, Lynch CF, Pukkala E, Storm HH, Vaalavirta L, van den Belt-Dusebout AW, Travis LB, Morton LM. Increased stomach cancer risk following radiotherapy for testicular cancer. Br J Cancer 2015; 112:44-51. [PMID: 25349972 PMCID: PMC4453604 DOI: 10.1038/bjc.2014.552] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Abdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose-response relationship are sparse. METHODS In a cohort of 22,269 5-year TC survivors diagnosed during 1959-1987, doses to stomach subsites were estimated for 92 patients who developed stomach cancer and 180 matched controls. Chemotherapy details were recorded. Odds ratios (ORs) were estimated using logistic regression. RESULTS Cumulative incidence of second primary stomach cancer was 1.45% at 30 years after TC diagnosis. The TC survivors who received radiotherapy (87 (95%) cases, 151 (84%) controls) had a 5.9-fold (95% confidence interval (CI) 1.7-20.7) increased risk of stomach cancer. Risk increased with increasing stomach dose (P-trend<0.001), with an OR of 20.5 (3.7-114.3) for ⩾50.0 Gy compared with <10 Gy. Radiation-related risks remained elevated ⩾20 years after exposure (P<0.001). Risk after any chemotherapy was not elevated (OR=1.1; 95% CI 0.5-2.5; 14 cases and 23 controls). CONCLUSIONS Radiotherapy for TC involving parts of the stomach increased gastric cancer risk for several decades, with the highest risks after stomach doses of ⩾30 Gy. Clinicians should be aware of these excesses when previously irradiated TC survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed TC patients.
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Affiliation(s)
- M Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - S D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - M Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - P Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - E S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - S A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B M P Aleman
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - R E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - G M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - J F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - M Kaijser
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | | | - C F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - H H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - L Vaalavirta
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - A W van den Belt-Dusebout
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - L B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - L M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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Protective effect of royal jelly on fertility and biochemical parameters in bleomycin-induced male rats. IRANIAN JOURNAL OF REPRODUCTIVE MEDICINE 2014; 12:209-16. [PMID: 24799882 PMCID: PMC4009575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/30/2013] [Accepted: 11/22/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bleomycin (BL) is a glycopeptide antibiotic obtained from the bacterium Streptomyces verticillus which is routinely used for treatment of human cancers. Royal jelly (RJ) is a production from the hypo pharyngeal, mandibular and post cerebral glands of nurse bees. RJ consists of 66% water, 15% sugars, 5% lipids, and 13% proteins, essential amino acids and vitamins. OBJECTIVE The aim of present study was to evaluate protective effect of royal jelly on sperm parameters and malondialdehyde (MDA) production in rat. MATERIALS AND METHODS Forty adult male wistar rats (220±20gr) were randomly divided into 4 groups (n=10). Control group (CG) received normal saline 10 ml/kg twice a week with Intraperitoneal (I.P) for 48 days (0.3 ml/rat(. Royal Jelly group (RJG) received jelly (100 mg/kg daily) for 48 days orally. Bleomycin group (BLG) received BL (10 mg/kg twice a week) with I.P for 48 days. Royal Jelly+ Bleomycin group (RJ+BLG) received royal Jelly (100 mg/kg /day) orally concomitant with BL administration. Sperm count, motility, and viability were investigated and chromatin quality and DNA integrity were also analyzed. Serum testosterone and MDA concentrations were measured as well. RESULTS BL caused decline significantly (p<0.05) sperm count, sperm viability, motility as well as testosterone concentration compared to control group while significant (p<0.05) increases in immature sperm, sperm with damaged DNA and MDA concentration were announced in BL in comparison with CG and RJ+BLG. Royal jelly improved Bleomycin-induced toxicity on sperm parameters and testosterone and MDA concentrations. CONCLUSION The present results support the idea that BL adversely affects sperm parameters and MDA and the RJ with antioxidant properties has positive effects on these parameters. This article extracted from M.Sc. thesis. (Tayebeh amirshahi).
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Gilbert DC, Van As NJ, Huddart RA. Reducing treatment toxicities in the management of good prognosis testicular germ cell tumors. Expert Rev Anticancer Ther 2014; 9:223-33. [DOI: 10.1586/14737140.9.2.223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Horwich A, Fossa SD, Huddart R, Dearnaley DP, Stenning S, Aresu M, Bliss JM, Hall E. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer 2014; 110:256-63. [PMID: 24263066 PMCID: PMC3887279 DOI: 10.1038/bjc.2013.551] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/02/2013] [Accepted: 08/14/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant. METHODS We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51,151 person-years of follow-up. RESULTS Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47-1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39-1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic-abdominal sites the SIR was 1.62 (95% CI: 1.43-1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98-1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30-1.65, P<0.0001). CONCLUSION The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers.
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Affiliation(s)
- A Horwich
- Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK
| | - S D Fossa
- Norwegian Radium Hospital, Oslo, Norway
| | - R Huddart
- Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK
| | - D P Dearnaley
- Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK
| | - S Stenning
- The Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - M Aresu
- The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK
| | - J M Bliss
- The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK
| | - E Hall
- The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK
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Gandaglia G, Becker A, Trinh QD, Abdollah F, Schiffmann J, Roghmann F, Tian Z, Montorsi F, Briganti A, Karakiewicz P, Sun M. Long-term survival in patients with germ cell testicular cancer: A population-based competing-risks regression analysis. Eur J Surg Oncol 2014; 40:103-12. [DOI: 10.1016/j.ejso.2013.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/30/2013] [Accepted: 09/12/2013] [Indexed: 12/19/2022] Open
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Second malignancies in long-term testicular cancer survivors. Int Urol Nephrol 2013; 46:749-56. [PMID: 24096370 DOI: 10.1007/s11255-013-0554-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The objective of the present study is to analyze long-term testicular cancer (TC) survivors focusing on the correlation of therapeutic modalities used, the age of patients and second malignancy (SM) occurrence. PATIENTS AND METHODS A total of 1,367 patients with TC and different subsequent therapeutic procedures were followed up between 1970 and 2012. The occurrence of SM was analyzed by standard incidence ratios (SIR). SM occurred in 96 (7.0 %) patients with primary TC. RESULTS The most frequent SM was TC (SIR 27.4, n = 64); a significantly higher occurrence was observed after primary testicular seminoma. Prostate cancer appeared in 10 patients (SIR 5.2), with a mean age 54.9 years, while the typical age of patients in Slovakia was 71.4 years. Kidney cancer developed in 6 patients, a significant higher SIR was registered only after primary non-seminomas. The mean patient's age was 48.5 years, while the typical age of all male patients in Slovakia was 62.4 years. Other SM had no significantly higher SIR. Colorectal cancer appeared in 8 patients with primary TC, with a mean age 56.0 years, while the typical age of male patients with primary colorectal cancer in Slovakia was 67.1 years. Other non-testicular tumors appeared in 8 patients. SM occurs in 1.5 % of patients following orchiectomy alone, in 4.3 % following radiotherapy, 5.0 % following chemotherapy and in 4.4 % following combined chemo-radiotherapy. CONCLUSIONS Preliminary analyses indicate increased SM occurrence in patients with primary TC in comparison with the general population, and it also occurs in younger age at the time of SM diagnosis.
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Maselli J, Hales BF, Robaire B. The Effects of Chemotherapy with Bleomycin, Etoposide, and Cis-Platinum (BEP) on Rat Sperm Chromatin Remodeling, Fecundity and Testicular Gene Expression in the Progeny1. Biol Reprod 2013; 89:85. [DOI: 10.1095/biolreprod.113.110759] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fricker K, Thompson C, Meyer J. Assessment of concomitant testicular dose with radiochromic film. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2013; 36:269-77. [PMID: 23794085 DOI: 10.1007/s13246-013-0208-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/17/2013] [Indexed: 12/26/2022]
Abstract
To assess the suitability of EBT2 and XRQA2 Gafchromic film for measuring low doses in the periphery of treatment fields, and to measure the accumulative concomitant dose to the contralateral testis resulting from CT imaging, pre-treatment imaging (CBCT) and seminoma radiotherapy with and without gonadal shielding. Superficial peripheral dose measurements made using EBT2 Gafchromic film on the surface of water equivalent material were compared to measurements made with an ionisation chamber in a water phantom to evaluate the suitability and accuracy of the film dosimeter for such measurements. Similarly, XRQA2 was used to measure surface doses within a kilovoltage beam and compared with ionisation chamber measurements. Gafchromic film was used to measure CT, CBCT and seminoma treatment related testicular doses on an anthropomorphic phantom. Doses were assessed for two clinical plans, both with and without gonadal shielding. Testicular doses resulting from the treatment of up to 0.83 ± 0.17 Gy were measured per treatment. Additional doses of up to 0.49 ± 0.01 and 2.35 ± 0.05 cGy were measured per CBCT and CT image, respectively. Reductions in the testicular dose in the order of 10, 36 and 78% were observed when gonadal shielding was fitted for treatment, CT and CBCT imaging, respectively. Gafchromic film was found to be suitable for measuring dose in the periphery of treatment fields. The dose to the testis should be limited to minimise the risk of radiation related side effects. This can be achieved by using appropriate gonadal shielding, irrespective of the treatment fields employed.
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Affiliation(s)
- Katherine Fricker
- Department of Physics and Astronomy, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand.
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31
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Sharpe RM, Mitchell RT. The downside of 'inappropriate messaging': new insight into the development of testicular germ cell tumours in young men? J Pathol 2013; 229:497-501. [PMID: 23335366 DOI: 10.1002/path.4167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 12/30/2012] [Accepted: 01/01/2013] [Indexed: 12/19/2022]
Abstract
How invasive testicular germ cell tumours (TGCTs) develop from precursor carcinoma in situ/intratubular germ cell neoplasia unclassified (CIS/IGCNU) cells, and only after puberty, is unknown. In the current issue of The Journal of Pathology, Jørgensen and colleagues have compared the protein expression profile of CIS before and after puberty and in pre-invasive versus invasive TGCT and show that the mitosis-meiosis controller DMRT1 switches off in CIS cells postpubertally and is associated with invasiveness. They also show that CIS cells express a 'confusing' mix of pro- and anti-meiotic proteins; this may predispose CIS cells to accumulate extra chromosomal material which ultimately leads to tumourigenesis.
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Affiliation(s)
- Richard M Sharpe
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
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Thong AE, Lichtensztajn DY, Almario L, Ingels A, Gomez SL, Gonzalgo ML. Stage I testicular seminoma: a SEER analysis of contemporary adjuvant radiotherapy trends. J Urol 2013; 190:1240-4. [PMID: 23567749 DOI: 10.1016/j.juro.2013.03.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80% of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100%. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. MATERIALS AND METHODS A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. RESULTS The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7% of patients received radiation, compared with only 37.7% of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95% CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95% CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95% CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. CONCLUSIONS The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.
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Affiliation(s)
- Alan E Thong
- Department of Urology, Stanford University School of Medicine, Stanford, California
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Improving the therapeutic ratio by using proton therapy in patients with stage I or II seminoma. Am J Clin Oncol 2013; 36:31-7. [PMID: 22134517 DOI: 10.1097/coc.0b013e3182354b9e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of the present study was to evaluate possible dosimetric advantages of proton therapy (PT) compared with 3-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT) in the treatment of patients with stage I and II seminoma. METHODS Two representative patients (1 with left-sided and 1 with right-sided seminoma) underwent treatment planning for stage I seminoma (paraaortic lymph nodes alone) with 3DCRT (PA3d), IMRT (PAimrt) double-scatter protons (PAPds), and uniform-scanning protons (PAPus) and for stage II seminoma (paraaortics lymph nodes and iliac nodes) with 3DCRT (PI3d) , IMRT (PIimrt) double-scatter protons (PIPds), and uniform-scanning protons (PIPus). The doses to the organs at risk were compared for photons and protons. RESULTS For stage I seminoma, PT reduced the mean dose to the stomach, ipsilateral kidney, pancreas, bowel space, small bowel, and colon compared with 3DCRT and IMRT. For stage II seminoma, PT reduced the mean dose to the same organs as in stage I seminoma with additional reductions in mean dose to the bladder and rectum compared with 3DCRT and IMRT. Uniform-scanning protons further reduced the dose to the organs at risk compared with double-scatter protons. CONCLUSIONS PT may offer an improvement in the therapeutic ratio in patients with seminoma by reducing the dose to normal tissue. This improvement may translate into lower risks of acute gastrointestinal side effects, infertility, and secondary malignancies, which should be explored in a prospective study.
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Singhera M, Lees K, Huddart R, Horwich A. Minimizing toxicity in early-stage testicular cancer treatment. Expert Rev Anticancer Ther 2012; 12:185-93. [PMID: 22316366 DOI: 10.1586/era.11.212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Testicular cancer is the paradigm of a curable malignancy, with 10-year survival rates exceeding 95%. Cisplatin-based regimes offer a survival gain of several decades of life; however, measures of outcomes in testicular cancer are evolving. Survivorship issues are becoming increasingly important in this young adult population. Long-term risks of second malignancy and cardiovascular disease secondary to chemotherapy and radiotherapy have been extensively documented, leading to an increased uptake of surveillance. However, the optimal surveillance schedule is not universally agreed upon. Research into modalities to detect relapse and frequency is ongoing. Reducing the treatment burden with fewer cycles of chemotherapy (one cycle of bleomycin, cisplatin and etoposide instead of two for stage I high-risk nonseminomatous tumors) or less toxic alternatives (carboplatin instead of radiotherapy for stage I seminomas) is currently being explored. This article details the toxicities associated with the diagnosis and treatments of early-stage testicular cancer and current strategies used to minimize toxicity while retaining the excellent cure rates.
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Affiliation(s)
- Mausam Singhera
- Institute of Cancer Research and Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK
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35
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Calabrò F, Albers P, Bokemeyer C, Martin C, Einhorn LH, Horwich A, Krege S, Schmoll HJ, Sternberg CN, Daugaard G. The Contemporary Role of Chemotherapy for Advanced Testis Cancer: A Systematic Review of the Literature. Eur Urol 2012; 61:1212-21. [DOI: 10.1016/j.eururo.2012.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 03/16/2012] [Indexed: 10/28/2022]
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Maselli J, Hales BF, Chan P, Robaire B. Exposure to bleomycin, etoposide, and cis-platinum alters rat sperm chromatin integrity and sperm head protein profile. Biol Reprod 2012; 86:166, 1-10. [PMID: 22402960 DOI: 10.1095/biolreprod.111.098616] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Testicular cancer, currently the most common cancer affecting men of reproductive age, is one of the most curable malignancies due to the progress made in the early diagnosis and effective treatment of this disease. The coadministration of bleomycin, etoposide, and cis-platinum (BEP) has brought the 5-yr survival rate of testis cancer patients to over 90%. However, this treatment results in reproductive chemotoxic effects. We assessed the effect of BEP treatment on sperm chromatin integrity and sperm head protein profiles of adult male Brown Norway rats following 9 wk of treatment with BEP and in animals treated for 9 wk and then subjected to a 9-wk recovery period. Both the susceptibility of DNA to denaturation and the number of strand breaks were significantly increased in mature sperm following 9 wk of treatment with BEP; proteomic analysis revealed that the expression of several proteins, including HSP90AA1 and HSP90B1, was markedly affected. Following a 9-wk recovery period, mature sperm did not show significant DNA damage, indicating that repair had potentially occurred. Interestingly, the protamination level of the sperm of these animals was significantly decreased, while histones HIST1H1D (H1.2), HIST1H4B (H4), HIST2H2AA3 (H2A1), and HIST1H2BA (H2B1A) were concomitantly up-regulated; this was not observed in the sperm immediately following 9 wk of treatment. Thus, there are persistent effects on proteins in sperm heads from the cauda epididymidis 9 wk posttreatment, in the absence of DNA strand breaks. We suggest that these effects on the sperm head proteome may contribute to long-lasting adverse effects in the progeny of BEP-exposed males.
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Affiliation(s)
- Jennifer Maselli
- Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
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37
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Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna M. [EAU guidelines on testicular cancer: 2011 update. European Association of Urology]. Actas Urol Esp 2012; 36:127-45. [PMID: 22188753 DOI: 10.1016/j.acuro.2011.06.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 06/28/2011] [Indexed: 12/31/2022]
Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account. TAKE HOME MESSAGE Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.
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Abstract
Because of a rising incidence of, and declining mortality from, testicular cancer, there are an increasing number of survivors of testicular cancer. Given their young age at diagnosis, the survivors have many years of life ahead of them during which they may experience adverse consequences from cancer and its treatment. Over the past few decades and particularly in this century, research into the short- and long-term effects of treatments of testicular cancer has grown rapidly, and now there exist a much greater body of data to help us counsel patients about the risks and side effects of these treatments.
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Affiliation(s)
- Timothy Gilligan
- Late Effects Clinic, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, R35, Cleveland, OH 44195, USA.
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39
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Brenner DJ, Shuryak I. Ten years of follow-up is not long enough to assess lifetime cancer risks caused by computed tomography scans in a young population. J Clin Oncol 2011; 29:4062; author reply 4062. [PMID: 21931034 DOI: 10.1200/jco.2011.37.9354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Lewinshtein D, Gulati R, Nelson PS, Porter CR. Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma. BJU Int 2011; 109:706-12. [PMID: 21883828 DOI: 10.1111/j.1464-410x.2011.10424.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES • To determine the use of adjuvant external beam radiotherapy (EBRT) for patients with clinical stage I testicular seminoma in the USA. • To quantify the risk of specific second primary malignancies (SPMs) associated with radiation exposure in these patients. PATIENTS AND METHODS • We used the Surveillance, Epidemiology and End Results database to identify patients diagnosed with clinical stage I testicular seminoma between 1973 and 2000. • We evaluated the use of EBRT in these patients. • We calculated standardized incidence ratios of specific SPMs in these patients. • We stratified the incidence of SPMs based on age at seminoma diagnosis and time to SPM from initial seminoma diagnosis. RESULTS • Adjuvant EBRT use declined from the first decade of the study period to the last decade of the study period (80.6% vs 70.2%). • Overall, there was a 19% increase in SPMs in patients exposed to EBRT (observed/expected, O/E, 1.51; 95% CI, 1.08-1.31) compared to the general population. • Specifically, significantly increased risks were observed for thyroid cancer (O/E, 2.32; 95% CI, 1.16-4.16), pancreatic cancer (O/E, 2.38; 95% CI, 1.43-3.72), non-bladder urothelial malignancies (O/E, 4.27; 95% CI, 1.57-9.29), bladder cancer (O/E, 1.47; 95% CI, 1.01-2.28), all haematological malignancies (O/E, 1.44; 95% CI, 1.08-1.89) and non-Hodgkin's lymphoma (O/E, 1.77; 95% CI, 1.22-2.48). • Patients had a persistently elevated risk of SPMs 15 years from the time of initial clinical stage I testicular seminoma diagnosis (O/E, 1.29; 95% CI, 1.10-1.49). CONCLUSIONS • We confirmed the increased risk of SPMs after EBRT for seminoma, and we identified the specific types of SPMs that develop. • The risk of EBRT-associated SPM persists for years after the initial seminoma diagnosis, and patients should be informed about these long-term risks.
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Affiliation(s)
- Dan Lewinshtein
- Virginia Mason Medical Center - Urology and Renal Transplantation, Fred Hutchinson Cancer Research Center - Human Biology, Seattle, WA, USA.
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41
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Abouassaly R, Fossa SD, Giwercman A, Kollmannsberger C, Motzer RJ, Schmoll HJ, Sternberg CN. Sequelae of treatment in long-term survivors of testis cancer. Eur Urol 2011; 60:516-26. [PMID: 21684072 DOI: 10.1016/j.eururo.2011.05.055] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 05/30/2011] [Indexed: 11/25/2022]
Abstract
CONTEXT Testicular cancer patients are often diagnosed at a young age, and because of the advances in the treatment of this disease, the vast majority have a normal life expectancy after therapy. Thus, recognition of the long-term sequelae of treatment (ie, surgery, radiation therapy, and chemotherapy) is particularly important in these patients. OBJECTIVE To review the adverse effects and the risk of secondary malignancy in long-term survivors of testicular cancer. EVIDENCE ACQUISITION We conducted a Medline search to identify original articles and reviews on the long-term effects of testicular cancer treatment. Although the search included articles from January 1948 to February 2011, the majority of the included articles were published in the last two decades. EVIDENCE SYNTHESIS All studies examining the long-term sequelae of treatment in testicular cancer are retrospective in nature, with most classified as cohort, case-control, and/or epidemiologic studies. Given that no standardized method of reporting long-term complications exists, evidence synthesis is limited. CONCLUSIONS Recent evidence suggests an increased risk of cardiovascular disease, neurotoxicity, and mild reductions in renal function in survivors of testicular cancer. Treatment of testicular malignancy can also negatively affect gonadal function and fertility and has been shown to result in an increased risk of solid malignancy and leukemia.
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Affiliation(s)
- Robert Abouassaly
- Urological Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA.
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42
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Abstract
CONTEXT On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established. OBJECTIVE This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer. EVIDENCE ACQUISITION Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned. RESULTS There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended. CONCLUSIONS These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.
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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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44
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Simone CB, Kramer K, O'Meara WP, Bekelman JE, Belard A, McDonough J, O'Connell J. Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma. Int J Radiat Oncol Biol Phys 2011; 82:242-9. [PMID: 21236595 DOI: 10.1016/j.ijrobp.2010.11.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 11/07/2010] [Accepted: 11/22/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE Photon radiotherapy has been the standard adjuvant treatment for stage I seminoma. Single-dose carboplatin therapy and observation have emerged as alternative options due to concerns for acute toxicities and secondary malignancies from radiation. In this institutional review board-approved study, we compared photon and proton radiotherapy for stage I seminoma and the predicted rates of excess secondary malignancies for both treatment modalities. METHODS AND MATERIAL Computed tomography images from 10 consecutive patients with stage I seminoma were used to quantify dosimetric differences between photon and proton therapies. Structures reported to be at increased risk for secondary malignancies and in-field critical structures were contoured. Reported models of organ-specific radiation-induced cancer incidence rates based on organ equivalent dose were used to determine the excess absolute risk of secondary malignancies. Calculated values were compared with tumor registry reports of excess secondary malignancies among testicular cancer survivors. RESULTS Photon and proton plans provided comparable target volume coverage. Proton plans delivered significantly lower mean doses to all examined normal tissues, except for the kidneys. The greatest absolute reduction in mean dose was observed for the stomach (119 cGy for proton plans vs. 768 cGy for photon plans; p < 0.0001). Significantly more excess secondary cancers per 10,000 patients/year were predicted for photon radiation than for proton radiation to the stomach (4.11; 95% confidence interval [CI], 3.22-5.01), large bowel (0.81; 95% CI, 0.39-1.01), and bladder (0.03; 95% CI, 0.01-0.58), while no difference was demonstrated for radiation to the pancreas (0.02; 95% CI, -0.01-0.06). CONCLUSIONS For patients with stage I seminoma, proton radiation therapy reduced the predicted secondary cancer risk compared with photon therapy. We predict a reduction of one additional secondary cancer for every 50 patients with a life expectancy of 40 years from the time of radiation treatment with protons instead of photons. Proton radiation therapy also allowed significant sparing of most critical structures examined and warrants further study for patients with seminoma, to decrease radiation-induced toxicity.
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Affiliation(s)
- Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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45
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Wethal T, Haugnes H, Kjekshus J, Småstuen M, Ueland T, Aukrust P, Fosså S. C-reactive protein; a potential marker of second cancer and cardiovascular disease in testicular cancer survivors? Eur J Cancer 2010; 46:3425-33. [DOI: 10.1016/j.ejca.2010.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Revised: 07/28/2010] [Accepted: 08/09/2010] [Indexed: 10/19/2022]
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46
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Pliarchopoulou K, Pectasides D. Late complications of chemotherapy in testicular cancer. Cancer Treat Rev 2010; 36:262-7. [PMID: 20092952 DOI: 10.1016/j.ctrv.2009.12.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/15/2009] [Accepted: 12/21/2009] [Indexed: 11/16/2022]
Abstract
Cisplatin-based treatment has significantly increased survival in testicular cancer patients. Therefore, there has been enough interest for the late toxic effects of chemotherapy which affect the quality of life of the cancer survivors. These toxic effects may either persist or present long after the end of chemotherapy and involve the impairment of renal function, neurotoxicity, pulmonary toxicity and vascular disease. Also, a major issue experienced by a large number of patients is infertility, which has been improved due to modified surgical techniques, reduced treatment intensity, the use of sperm cryopreservation and methods of assisted reproduction. Physicians should also be aware of the risk of secondary malignancy development. Therefore, close follow-up of the testicular cancer survivors as well as, focus on minimizing treatment complications through improvement of treatment strategies are warranted.
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Affiliation(s)
- Kyriaki Pliarchopoulou
- Second Department of Internal Medicine, Propaedeutic Oncology Section, University of Athens, Attikon University Hospital, Rimini 1, Haidari, Athens, Greece.
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Roles of radiation dose and chemotherapy in the etiology of stomach cancer as a second malignancy. Int J Radiat Oncol Biol Phys 2009; 75:1420-9. [PMID: 19931732 DOI: 10.1016/j.ijrobp.2009.01.073] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 12/24/2008] [Accepted: 01/09/2009] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the roles of radiation dose, chemotherapy, and other factors in the etiology of stomach cancer in long-term survivors of testicular cancer or Hodgkin lymphoma. METHODS AND MATERIALS We conducted a cohort study in 5,142 survivors of testicular cancer or Hodgkin lymphoma treated in the Netherlands between 1965 and 1995. In a nested case-control study, detailed information on treatment, smoking, gastrointestinal diseases, and family history was collected for 42 patients with stomach cancer and 126 matched controls. For each subject, the mean radiation dose to the stomach was estimated. Relative risks (RRs) of stomach cancer and the radiation-related excess relative risk (ERR) per gray were calculated by conditional logistic regression analysis. RESULTS The risk of stomach cancer was 3.4-fold increased compared with the general population. The risk increased with increasing mean stomach dose (p for trend, <0.001), at an ERR of 0.84 per Gy (95% confidence interval [CI], 0.12-15.6). Mean stomach doses of more than 20 Gy were associated with a RR of 9.9 (95% CI, 3.2-31.2) compared with doses below 11 Gy. The risk was 1.8-fold (95% CI, 0.8-4.4) increased after chemotherapy and 5.4-fold (95% CI, 1.2-23.9) increased after high doses of procarbazine (>or=13,000 mg) vs. <10,000 mg. The RR of smoking more than 10 cigarettes per day vs. no smoking was 1.6 (95% CI, 0.6-4.2). CONCLUSIONS Stomach cancer risk is strongly radiation dose dependent. The role of chemotherapy, particularly of procarbazine and related agents, needs further study, because of the relatively small numbers of chemotherapy-treated subjects.
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Fosså SD, Oldenburg J, Dahl AA. Short- and long-term morbidity after treatment for testicular cancer. BJU Int 2009; 104:1418-22. [PMID: 19840023 DOI: 10.1111/j.1464-410x.2009.08869.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with testicular cancer are at risk of having severe short-term and life-threatening long-term effects; we reviewed previous reports of these sequelae. After orchidectomy and before further treatment patients have major mental distress which gradually decreases during the treatment phase. Gastrointestinal side-effects dominate during both chemo- and radiotherapy, with the risk of severe haematological, infectious and thromboembolic complications during chemotherapy. Long-term sequelae comprise second cancers, cardiovascular morbidity/mortality and gonadal dysfunction. Nevertheless, 70% of patients who attempt paternity after treatment are successful. About 20% of patients develop long-term neuro- and/or ototoxicity. The long-term quality of life of survivors of testicular cancer is comparable to that of controls. Risk-adapted treatment of patients with testicular cancer and adequate follow-up of those at risk of life-threatening toxicity are ways to reduce the short- and long-term morbidity in survivors. Patients should be informed about these potential complications and the importance of adjusting their lifestyle (e.g. smoking habits, physical activity and weight control).
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Affiliation(s)
- Sophie D Fosså
- The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
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Affiliation(s)
- Padraig Warde
- Department of Radiation Oncology, University of Toronto and the Radiation Medicine Program Princess Margaret Hospital, Toronto, Canada.
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Huddart RA. Stage I germ cell tumours: achieving cure at minimal cost. Clin Oncol (R Coll Radiol) 2009; 22:1-5. [PMID: 19781923 DOI: 10.1016/j.clon.2009.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2009] [Accepted: 08/10/2009] [Indexed: 01/10/2023]
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