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Shiao JC, Shen X. Contemporary Role of Radiation Therapy in Testicular Cancer. Urol Clin North Am 2024; 51:395-405. [PMID: 38925742 DOI: 10.1016/j.ucl.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Testicular cancer is a rare but curable male malignancy. Seminoma represents the majority of germ cell tumors and is considered radiation sensitive. Radiation treatment plays a role in adjuvant therapy after orchiectomy of stage I, IIA, and IIB seminomas. Radiation dose de-escalation has been effective in preventing tumor recurrences while also limiting acute and long-term toxicities. However, long-term risks, including the prevailing concern of secondary malignancy risk, between adjuvant radiation and chemotherapy play a role in recommendations. Ongoing work continues to be performed to reduce radiation field and dose in combination with chemotherapy while still maintaining excellent outcomes.
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Affiliation(s)
- Jay C Shiao
- Department of Radiation Oncology, University of Kansas Cancer Center, 4001 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Xinglei Shen
- Department of Radiation Oncology, University of Kansas Cancer Center, 4001 Rainbow Boulevard, Kansas City, KS 66160, USA
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2
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Xia L, Daneshmand S. Update on the Management of Low-stage Seminoma. Urol Clin North Am 2024; 51:377-385. [PMID: 38925740 DOI: 10.1016/j.ucl.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
The contemporary paradigm of testicular cancer management is achieving high and durable cure rates while minimizing the burden of treatment given the potential long-term toxicities associated with radiation therapy and systemic therapies. The management of low-stage seminoma has seen significant changes in recent years. Nuances of surveillance strategies for stage I seminoma exist and continue to evolve. Emerging data show retroperitoneal lymph node dissection is a viable treatment option for selected patients with clinical stage IIA and IIB seminoma.
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Affiliation(s)
- Leilei Xia
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA.
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA
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Tapia JC, Gavira J, Anguera G, Sanchez S, Romano A, Bosma F, Molina A, Sanz-Beltran J, Martin-Lorente C, Algaba F, Maroto P. Cumulative incidences of hypogonadism, hypertension, and dyslipidaemia in patients with stage I seminoma treated with a risk-adapted strategy: a Spanish single-centre retrospective analysis. Clin Transl Oncol 2024; 26:1798-1803. [PMID: 38421563 DOI: 10.1007/s12094-024-03393-9] [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: 12/13/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE To describe the incidences of hypogonadism, hypertension, and dyslipidaemia in patients with stage 1 seminoma (S1S) testicular cancer (TC) treated with a risk-adapted strategy. METHODS A retrospective analysis from 2000 to 2020 was conducted. Active surveillance (AS), carboplatin one cycle, and carboplatin two cycles were offered according to risk factors. Cumulative incidences and relapse-free survival (RFS) were estimated. RESULTS Of the 145 patients, 8 (5.4%) were excluded due to bilateral TC or hypogonadism at diagnosis. Median follow-up time was 8.2 years. Eighty-four, 30, and 33 patients were treated with AS, carboplatin one cycle, and carboplatin two cycles, respectively. In the overall population, the 5-year and 10-year cumulative incidences were 1.6% and 5.3% for hypogonadism; 2.0% and 8.6% for hypertension; and 12.4% and 25.1% for dyslipidaemia. No statistically significant differences were found in the incidences among the three adjuvant strategies. Five-year and 10-year RFS were 85.9% and 83.3% for AS; 92.4% and 84.0% for carboplatin one cycle; and 96.7% at both times for carboplatin two cycles. CONCLUSION There were no statistically differences in cumulative incidences of hypogonadism, hypertension, and dyslipidaemia in S1S patients treated with a risk-adapted strategy.
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Affiliation(s)
- Jose C Tapia
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain.
| | - Javier Gavira
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Georgia Anguera
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sofia Sanchez
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Alejandra Romano
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Freya Bosma
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Alejandra Molina
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Judit Sanz-Beltran
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Cristina Martin-Lorente
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
| | - Fernando Algaba
- Pathology Department, Fundació Puigvert, Cartagena 340, 08025, Barcelona, Spain
| | - Pablo Maroto
- Department of Medical Oncology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Sant Quintí, 89, 08041, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Universitat Autònoma de Barcelona, Barcelona, Spain
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Daugaard G, Lauritsen J, Bandak M, Agerbæk M, Als AB, Dysager L, Toft BG, Engvad B, Berney DM, Wagner T. Use of Risk Factors To Select Adjuvant Therapy Versus Surveillance for Testicular Nonseminoma and Seminoma Germ Cell Tumors. Eur Urol Focus 2024:S2405-4569(24)00090-7. [PMID: 38871631 DOI: 10.1016/j.euf.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/22/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
New risk factors associated with relapse of stage I testicular cancer have been identified. These new factors reflect the risk of recurrence much better than previous parameters and can be used to assess the possible effect of adjuvant chemotherapy.
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Affiliation(s)
- Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne B Als
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Birgitte G Toft
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birte Engvad
- Department of Pathology, Odense University Hospital, Denmark
| | - Daniel M Berney
- Centre of Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Boormans JL, Sylvester R, Anson-Cartwright L, Glicksman RM, Hamilton RJ, Hahn E, Daugaard G, Lauritsen J, Wagner T, Avuzzi B, Nicolai N, Del Muro XG, Aparicio J, Stalder O, Rothermundt C, Fischer S, Laguna MP. Prognostic Factor Risk Groups for Clinical Stage I Seminoma: An Individual Patient Data Analysis by the European Association of Urology Testicular Cancer Guidelines Panel and Guidelines Office. Eur Urol Oncol 2024; 7:537-543. [PMID: 37951820 DOI: 10.1016/j.euo.2023.10.014] [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: 09/07/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The relapse rate in patients with clinical stage I (CSI) seminomatous germ cell tumor of the testis (SGCTT) who were undergoing surveillance after radical orchidectomy is 4-30%, depending on tumor size and rete testis invasion (RTI). However, the level of evidence supporting the use of both risk factors in clinical decision-making is low. OBJECTIVE We aimed to identify the most important prognostic factors for relapse in CSI SGCTT patients. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 1016 CSI SGCTT patients diagnosed between 1994 and 2019 with normal postorchidectomy serum tumor marker levels and undergoing surveillance were collected from nine institutions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable Cox proportional hazard regression models were fit to identify the most important prognostic factors. The primary endpoint was the time to first relapse by imaging and/or markers. Relapse probabilities were estimated by the Kaplan-Meier method. RESULTS AND LIMITATIONS After a median follow-up of 7.7 yr, 149 (14.7%) patients had relapsed. Categorical tumor size (≤2, >2-5, and >5 cm), presence of RTI, and lymphovascular invasion were used to form three risk groups: low (56.4%), intermediate (41.3%), and high (2.3%) risks with 5-yr cumulative relapse probabilities of 8%, 20%, and 44%, respectively. The model outperformed the currently used model with tumor size ≤4 versus >4 cm and presence of RTI (Harrell's C index 0.65 vs 0.61). The low- and intermediate-risk groups were validated successfully in an independent cohort of 285 patients. CONCLUSIONS The risk of relapse after radical orchidectomy in CSI SGCTT patients under surveillance is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse. PATIENT SUMMARY The risk of relapse after radical orchidectomy in patients with clinical stage I seminomatous germ cell tumor of the testis is low. We propose a new risk stratification model that outperformed the current model and identified a small subgroup with a high risk of relapse.
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Affiliation(s)
- Joost L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Richard Sylvester
- European Association of Urology Guidelines Office, Brussels, Belgium
| | - Lynn Anson-Cartwright
- Department of Surgery (Urology), Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Robert J Hamilton
- Department of Surgery (Urology), Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ezra Hahn
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gedske Daugaard
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Barbara Avuzzi
- Radiation Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
| | - Xavier García Del Muro
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain(1)
| | - Jorge Aparicio
- Department of Medical Oncology, Hospital Universitario y Politécnico La Fe, Valencia, Spain(1)
| | - Odile Stalder
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Stefanie Fischer
- Department of Medical Oncology and Haematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - M Pilar Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
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Erkan A, Keten T, Guzel O, Barali D, Basboga S, Kilic M, Caglayan V, Koc A, Tuncel A. Patients with testicular cancer receiving adjuvant chemotherapy: Compliance with follow-up in the first three years. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102607. [PMID: 38431081 DOI: 10.1016/j.fjurol.2024.102607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE The aim of this study was to investigate the compliance with follow-up in patients receiving adjuvant chemotherapy (ACT) for testicular cancer at two academic hospitals. MATERIALS AND METHODS The study analyzed 104 patients with testicular tumors who had undergone surgery at least a year before and received ACT between March 2017 to March 2022. The mean follow-up was 29.2±16.2 (12-73) months. Patients were classified as fully compliant (100% compliance), moderately compliant (50-99%), poorly compliant (1-49%), and non-compliant (no attendance) according to their compliance with the follow-up schedule. RESULTS At the end of the first year, 76% of patients were fully compliant. By the end of the second year, this number dropped to 50%. Furthermore, 25% of patients were identified as non-compliant in the second year and only 4.3% in the third year. When comparing patients who were compliant and non-compliant at first- and second-year follow-up, no statistically significant difference was found according to age, tumor size, disease stage, or ACT regimen (P=0.938, P=0.784, P=0.867, and P=0.282, respectively). CONCLUSION This study showed that full compliance with follow-up gradually decreased over the years and that the factors examined were not able to predict this decrease. Prospective studies can help design individualized education and follow-up programs, considering each patient's tumor stage. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Anil Erkan
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, 16140 Bursa, Turkey.
| | - Tanju Keten
- University of Health Sciences, Ankara City Hospital, Department of Urology, Ankara, Turkey
| | - Ozer Guzel
- University of Health Sciences, Ankara City Hospital, Department of Urology, Ankara, Turkey
| | - Deniz Barali
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, 16140 Bursa, Turkey
| | - Serdar Basboga
- University of Health Sciences, Ankara City Hospital, Department of Urology, Ankara, Turkey
| | - Metin Kilic
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, 16140 Bursa, Turkey
| | - Volkan Caglayan
- University of Health Sciences, Bursa City Hospital, Department of Urology, Bursa, Turkey
| | - Akif Koc
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Urology, 16140 Bursa, Turkey
| | - Altug Tuncel
- University of Health Sciences, Ankara City Hospital, Department of Urology, Ankara, Turkey
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Fang F, Sun Y, Huang H, Huang Y, Luo X, Yao W, Wei L, Xie G, Wu Y, Lu Z, Zhao J, Li C. Ultrasound-based deep learning radiomics nomogram for risk stratification of testicular masses: a two-center study. J Cancer Res Clin Oncol 2024; 150:18. [PMID: 38240867 PMCID: PMC10798931 DOI: 10.1007/s00432-023-05549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/22/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To develop an ultrasound-driven clinical deep learning radiomics (CDLR) model for stratifying the risk of testicular masses, aiming to guide individualized treatment and minimize unnecessary procedures. METHODS We retrospectively analyzed 275 patients with confirmed testicular lesions (January 2018 to April 2023) from two hospitals, split into training (158 cases), validation (68 cases), and external test cohorts (49 cases). Radiomics and deep learning (DL) features were extracted from preoperative ultrasound images. Following feature selection, we utilized logistic regression (LR) to establish a deep learning radiomics (DLR) model and subsequently derived its signature. Clinical data underwent univariate and multivariate LR analyses, forming the "clinic signature." By integrating the DLR and clinic signatures using multivariable LR, we formulated the CDLR nomogram for testicular mass risk stratification. The model's efficacy was gauged using the area under the receiver operating characteristic curve (AUC), while its clinical utility was appraised with decision curve analysis(DCA). Additionally, we compared these models with two radiologists' assessments (5-8 years of practice). RESULTS The CDLR nomogram showcased exceptional precision in distinguishing testicular tumors from non-tumorous lesions, registering AUCs of 0.909 (internal validation) and 0.835 (external validation). It also excelled in discerning malignant from benign testicular masses, posting AUCs of 0.851 (internal validation) and 0.834 (external validation). Notably, CDLR surpassed the clinical model, standalone DLR, and the evaluations of the two radiologists. CONCLUSION The CDLR nomogram offers a reliable tool for differentiating risks associated with testicular masses. It augments radiological diagnoses, facilitates personalized treatment approaches, and curtails unwarranted medical procedures.
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Affiliation(s)
- Fuxiang Fang
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Yan Sun
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Hualin Huang
- Department of Emergency, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yueting Huang
- Department of Epidemiology and Health Statistics, School of Public Health of Guangxi Medical University, Nanning, 530021, China
| | - Xing Luo
- Department of Urology, Baise People's Hospital, Baise, 533099, China
| | - Wei Yao
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Liyan Wei
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Guiwu Xie
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Yongxian Wu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Zheng Lu
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China
| | - Jiawen Zhao
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
| | - Chengyang Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, 530021, China.
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Wagner T, Toft BG, Lauritsen J, Bandak M, Christensen IJ, Engvad B, Kreiberg M, Agerbæk M, Dysager L, Rosenvilde JJ, Berney D, Daugaard G. Prognostic Factors for Relapse in Patients With Clinical Stage I Testicular Seminoma: A Nationwide, Population-Based Cohort Study. J Clin Oncol 2024; 42:81-89. [PMID: 37683134 DOI: 10.1200/jco.23.00959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/18/2023] [Accepted: 07/22/2023] [Indexed: 09/10/2023] Open
Abstract
PURPOSE Approximately 20% of patients with clinical stage I seminoma relapse. Tumor size and rete testis invasion have been identified as risk factors for relapse. However, the level of evidence supporting the use of these risk factors in clinical decision making is low. Previous studies have been hampered by selection bias and variable pathology reporting that limit interpretation and generalization of results. We assessed prognostic factors for relapse in an unselected nationwide population-based setting with centralized pathology review. METHODS Patients with clinical stage I seminoma diagnosed from January 2013 to December 2018 were identified in the prospective Danish Testicular Cancer database. By linkage to the Danish National Pathology Registry, histologic slides from the orchiectomy specimens were retrieved and reviewed blinded to the clinical outcome. Clinical data were obtained from medical records with follow-up until July 2022. The association between prespecified potential clinical and histopathologic prognostic factors and relapse was assessed by the use of Cox regression analysis. RESULTS Of 924 patients included, 148 (16%) patients relapsed during a median follow-up of 6.3 years. Invasion of the testicular hilum (rete testis and hilar soft tissue), lymphovascular invasion, and elevated preorchiectomy levels of β-human chorionic gonadotropin and lactate dehydrogenase were independent predictors of relapse. The estimated 5-year risk of relapse ranged from 6% in patients with no risk factors to 62% in patients with all four risk factors with tumor extension into the hilar soft tissue of the testicular hilum. After internal model validation, the prognostic model had an overall concordance statistic of 0.70. CONCLUSION The provided prognostic factors could replace current risk factors in guidelines and be used in future studies investigating risk-adapted follow-up and treatment strategies.
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Affiliation(s)
- Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Grønkær Toft
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birte Engvad
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Daniel Berney
- Centre of Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Yáñez-Castillo YM, Melgarejo-Segura MT, Gutiérrez-Tejero F, Arrabal-Martín M. Evaluation of tumour size and rete testis invasion in progression free survival of our patients with stage i testicular seminoma. A retrospective observational study of a reference hospital center and literature review. Actas Urol Esp 2023; 47:654-660. [PMID: 37355209 DOI: 10.1016/j.acuroe.2023.06.005] [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: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the impact of tumour size and rete testis invasion in progression free survival of our patients with stage I testicular seminoma. A literature review is also made. MATERIAL AND METHODS A retrospective observational study was performed. We included patients with stage I seminoma between January 2010 and July 2022. Patients without factors of poor prognostic -Group A- were compared with patients with factors of poor prognostic -Group B-. Kaplan-Meier curves and log-rank testing were used to compare progression free survival (PFS) between these groups. Statistical significance was considered at P≤.05. RESULTS 55 patients were included in this study. 20 patients (36.4%) were of good prognostic -Group A- and 35 (63.6%) had factors of poor prognostic -Group B-. The mean age was similar in both groups (mean±standard deviation), 38.62±9.04 years. The mean follow-up time was 63.5±33.6 months. All the patients in group A and 25.7% of the patients in group B underwent active surveillance (AS). 26 patients (74.3%) of the patients in Group B were treated with one cycle of adyuvant carboplatin. Three patients suffered a relapse with retroperitoneal lymph nodes (10.3%), all of them were treated with three cycles of BEP, with a complete response of the disease. No statistical significant differences were found in PFS between Group A and B (log Rank P=.317). CONCLUSION Individualization of adjuvant treatment in stage I seminoma is important, avoiding the adverse effects derived from them.
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Affiliation(s)
- Y M Yáñez-Castillo
- Departamento de Urología, Hospital Universitario San Cecilio, Granada, Spain.
| | | | - F Gutiérrez-Tejero
- Departamento de Urología, Hospital Universitario San Cecilio, Granada, Spain
| | - M Arrabal-Martín
- Departamento de Urología, Hospital Universitario San Cecilio, Granada, Spain
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Conduit C, Lewin J, Weickhardt A, Lynam J, Wong S, Grimison P, Sengupta S, Pranavan G, Parnis F, Bastick P, Campbell D, Hansen AR, Leonard M, McJannett M, Stockler MR, Gibbs P, Toner G, Davis ID, Tran B, Kuchel A. Patterns of Relapse in Australian Patients With Clinical Stage 1 Testicular Cancer: Utility of the Australian and New Zealand Urogenital and Prostate Cancer Trials Group Surveillance Recommendations. JCO Oncol Pract 2023; 19:973-980. [PMID: 37327464 DOI: 10.1200/op.23.00191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 06/18/2023] Open
Abstract
PURPOSE International guidelines advocate for active surveillance as the preferred treatment strategy for patients with stage 1 testicular cancer after orchidectomy although a personalized discussion is required. MATERIALS AND METHODS We conducted an analysis of individuals registered in iTestis, Australia's testicular cancer registry, to describe the patterns of relapse and outcomes of patients treated in Australia where the Australian and New Zealand Urogenital and Prostate Cancer Trials Group Surveillance Recommendations are widely adopted. RESULTS A total of 650 individuals diagnosed between 2000 and 2020 were included, 63% (411 of 650) seminoma and 37% (239 of 650) nonseminoma. The median age was 34 years (range 14-74). 26% (106 of 411) with seminoma and 15% (36 of 239) nonseminoma received adjuvant chemotherapy. After a median follow-up of 43 months (range 0-267) postorchidectomy, relapse occurred in 10% (43 of 411) of seminoma and 18% (43 of 239) of nonseminoma. The two-year relapse-free survival was 92% (95% CI, 89 to 95) and 82% (95% CI, 78 to 87) in seminoma and nonseminoma, respectively. All relapses (86 of 86) were detected at a routine surveillance visit; 98% (85 of 86) were asymptomatic and detected solely through imaging (62 of 86, 72%), tumor markers (6 of 86, 7%), or a combination (17 of 86, 20%). The most common relapse site was isolated retroperitoneal lymphadenopathy (53 of 86, 62%). No nonpulmonary visceral metastases occurred. At relapse, 98% (84 of 86) had International Germ Cell Cancer Collaborative Group (IGCCCG) good prognosis; 2 of 86 intermediate prognosis (both nonseminoma). No deaths occurred. CONCLUSION In our cohort of stage 1 testicular cancer, where national surveillance recommendations have been widely adopted, recurrences were detected at routine surveillance visits and, almost exclusively, asymptomatic with IGCCCG good-prognosis disease. This provides reassurance that active surveillance is safe.
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Affiliation(s)
- Ciara Conduit
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Jeremy Lewin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, VIC, Australia
| | - Andrew Weickhardt
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, VIC, Australia
- La Trobe University, Melbourne, VIC, Australia
- Department of Medical Oncology, Austin Health, Heidelberg, VIC, Australia
| | - James Lynam
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW, Australia
- University of Newcastle, Callaghan, NSW, Australia
| | - Shirley Wong
- Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Peter Grimison
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
| | - Shomik Sengupta
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Urology, Eastern Health, Box Hill, VIC, Australia
| | - Ganes Pranavan
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia
| | - Francis Parnis
- Department of Medical Oncology, Icon Cancer Centre, Adelaide, SA, Australia
| | - Patricia Bastick
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Southside Cancer Care Centre, Kogarah, NSW, Australia
- Department of Medical Oncology, St George/Sutherland Hospital, Caringbah, NSW, Australia
| | - David Campbell
- Department of Medical Oncology, Barwon Health, Geelong, VIC, Australia
| | - Aaron R Hansen
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- University of Queensland, Brisbane, QLD, Australia
| | - Matt Leonard
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Margaret McJannett
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Martin R Stockler
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- University of Sydney, Camperdown, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- Department of Medical Oncology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Western Health, Footscray, VIC, Australia
| | - Guy Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Ian D Davis
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- Monash University Eastern Health Clinical School, Box Hill, VIC, Australia
- Department of Medical Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Ben Tran
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
| | - Anna Kuchel
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, NSW, Australia
- University of Queensland, Brisbane, QLD, Australia
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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11
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Quaresma V, Henriques D, Marconi L, Lorigo J, Ferreira AM, Jarimba R, Nunes P, Figueiredo A, Parada B. Surveillance as a safe and effective option for treatment of stage I seminoma. Arch Ital Urol Androl 2023; 95:11513. [PMID: 37668558 DOI: 10.4081/aiua.2023.11513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/14/2023] [Indexed: 09/06/2023] Open
Abstract
Introdubction: Stage I seminoma has a very good prognosis, yet approximately 15% have subclinical metastatic disease and will relapse after orchidectomy alone. Several management approaches have been investigated. We aimed to evaluate the clinical outcomes of real-world patients with stage I seminoma, analysing prognostic factors influencing treatment choice and oncological outcomes. METHODS Retrospective, single institution study, with 55 patients diagnosed with clinical stage I seminoma between 2007 and 2020. Selected patients were analysed regarding three management approaches - surveillance, adjuvant radiotherapy and adjuvant carboplatin AUC7. Overall survival and progression-free survival outcomes were analysed. Predictors of treatment choice were determined, and predictors of recurrence were analysed in patients on active surveillance. RESULTS The median follow-up time was 91 months (13-165). Overall survival at 10 years was 98.2%. Stage I seminoma patients had a 1-, 3- and 10-year progression free survival of 98%, 94% and 89%, respectively. Three-year progression free survival was 92.0% for those on active surveillance (IC95%, 91.5-92.5%), 95.2% for carboplatin (IC95%, 94.8-95.6%) and 100% for those on adjuvant radiotherapy (p > 0.05). All relapses on active surveillance protocols occurred during the first 24 months. Overall, 43% of patients who underwent adjuvant treatment reported adverse effects of therapy, with higher incidence on radiotherapy group (63%). CONCLUSIONS Stage I seminoma have excellent prognosis, high cure rates, and low treatment-associated morbidity. Active surveillance is a safe modality when applied to selected patients. Adjuvant radiotherapy and adjuvant chemotherapy with carboplatin show similar results, with fewer adverse effects on chemotherapy arm.
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Affiliation(s)
- Vasco Quaresma
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | | | - Lorenzo Marconi
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - João Lorigo
- Urology Department, Centro Hospitalar e Universitário de Coimbra.
| | | | - Roberto Jarimba
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Pedro Nunes
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Arnaldo Figueiredo
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
| | - Belmiro Parada
- Urology Department, Centro Hospitalar e Universitário de Coimbra; Faculty of Medicine of the University of Coimbra.
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12
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Patrikidou A, Cazzaniga W, Berney D, Boormans J, de Angst I, Di Nardo D, Fankhauser C, Fischer S, Gravina C, Gremmels H, Heidenreich A, Janisch F, Leão R, Nicolai N, Oing C, Oldenburg J, Shepherd R, Tandstad T, Nicol D. European Association of Urology Guidelines on Testicular Cancer: 2023 Update. Eur Urol 2023; 84:289-301. [PMID: 37183161 DOI: 10.1016/j.eururo.2023.04.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
CONTEXT Each year the European Association of Urology (EAU) produce a document based on the most recent evidence on the diagnosis, therapy, and follow-up of testicular cancer (TC). OBJECTIVE To represent a summarised version of the EAU guidelines on TC for 2023 with a focus on key changes in the 2023 update. EVIDENCE ACQUISITION A multidisciplinary panel of TC experts, comprising urologists, medical and radiation oncologists, and pathologists, reviewed the results from a structured literature search to compile the guidelines document. Each recommendation in the guidelines was assigned a strength rating. EVIDENCE SYNTHESIS For the 2023 EAU guidelines on TC, a review and restructure were undertaken. The key changes incorporated in the 2023 update include: new supporting text regarding venous thromboembolism prophylaxis in males with metastatic germ cell tumours receiving chemotherapy; quality of life after treatment; an update of the histological classifications and inclusion of the World Health Organization 2022 pathological classification; inclusion of the revalidation of the 1997 International Germ Cell Cancer Collaborative Group prognostic risk factors; and a new section covering oncology treatment protocols. CONCLUSIONS The 2023 version of the EAU guidelines on TC include the highest available scientific evidence to standardise the management of TC. Better stratification and optimisation of treatment modalities will continue to improve the high survival rates for patients with TC. PATIENT SUMMARY This article presents a summary of the European Association of Urology guidelines on testicular cancer published in 2023 and includes the latest recommendations for management of this disease. The guidelines are a valuable resource that may help patients in understanding treatment recommendations.
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Affiliation(s)
- Anna Patrikidou
- Department of Oncology, Institut Gustave Roussy, Villejuif, France
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Joost Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Isabel de Angst
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Domenico Di Nardo
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Carmen Gravina
- Department of Urology, Sant'Andrea Hospital-Sapienza University, Rome, Italy
| | - Hendrik Gremmels
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ricardo Leão
- Department of Urology, Faculty of Medicine, University of Coimbra, Clinical Academic Center of Coimbra, Coimbra, Portugal
| | - Nicola Nicolai
- Department of Surgery, Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Christoph Oing
- Department of Oncology, Freeman Hospital NHS Foundation Trust, London, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lorenskog, Norway
| | - Robert Shepherd
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Torgrim Tandstad
- Department of Oncology, The Cancer Clinic, St. Olav's University Hospital, Trondheim, Norway
| | - David Nicol
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer research, London, UK.
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13
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Schrader M. [Surveillance of stage I seminoma-evidence-based guideline for clinical practice!]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:958-960. [PMID: 37322370 DOI: 10.1007/s00120-023-02130-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Mark Schrader
- Helios Klinikum Berlin Buch, Medical School Berlin, Schwanebecker Chaussee 30, 13125, Berlin, Deutschland.
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14
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Mertens RT, Gukathasan S, Arojojoye AS, Olelewe C, Awuah SG. Next Generation Gold Drugs and Probes: Chemistry and Biomedical Applications. Chem Rev 2023; 123:6612-6667. [PMID: 37071737 PMCID: PMC10317554 DOI: 10.1021/acs.chemrev.2c00649] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
The gold drugs, gold sodium thiomalate (Myocrisin), aurothioglucose (Solganal), and the orally administered auranofin (Ridaura), are utilized in modern medicine for the treatment of inflammatory arthritis including rheumatoid and juvenile arthritis; however, new gold agents have been slow to enter the clinic. Repurposing of auranofin in different disease indications such as cancer, parasitic, and microbial infections in the clinic has provided impetus for the development of new gold complexes for biomedical applications based on unique mechanistic insights differentiated from auranofin. Various chemical methods for the preparation of physiologically stable gold complexes and associated mechanisms have been explored in biomedicine such as therapeutics or chemical probes. In this Review, we discuss the chemistry of next generation gold drugs, which encompasses oxidation states, geometry, ligands, coordination, and organometallic compounds for infectious diseases, cancer, inflammation, and as tools for chemical biology via gold-protein interactions. We will focus on the development of gold agents in biomedicine within the past decade. The Review provides readers with an accessible overview of the utility, development, and mechanism of action of gold-based small molecules to establish context and basis for the thriving resurgence of gold in medicine.
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Affiliation(s)
- R Tyler Mertens
- Department of Chemistry, University of Kentucky, Lexington, Kentucky 40506, United States
| | - Sailajah Gukathasan
- Department of Chemistry, University of Kentucky, Lexington, Kentucky 40506, United States
| | - Adedamola S Arojojoye
- Department of Chemistry, University of Kentucky, Lexington, Kentucky 40506, United States
| | - Chibuzor Olelewe
- Department of Chemistry, University of Kentucky, Lexington, Kentucky 40506, United States
| | - Samuel G Awuah
- Department of Chemistry, University of Kentucky, Lexington, Kentucky 40506, United States
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Kentucky, Lexington, Kentucky 40536, United States
- University of Kentucky Markey Cancer Center, Lexington, Kentucky 40536, United States
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15
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Mahmoud Sayed M, Nasr AM, Saad Eldin IM, Abdelazim YA. Stage I seminoma: Outcome of different treatment modalities and changes in patterns of care. A single institution experience. Arch Ital Urol Androl 2023; 95:11057. [PMID: 36924377 DOI: 10.4081/aiua.2023.11057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/03/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The mainstay for management of stage I seminoma is high inguinal orchiectomy with post-orchiectomy therapeutic options including active surveillance, chemotherapy or radiation therapy. OBJECTIVES To analyze different post-orchiectomy treatment modalities outcomes of stage I seminoma patients presented to NCI, Cairo University in the period from 2005-2019. PATIENTS AND METHODS A retrospective review of all patients' records with clinical stage I seminoma who presented to our institute in the period from 2005-2019 was done. Adjuvant treatment details were extracted and we compared overall survival (OS) and disease free survival (DFS) for different modalities and changes in patterns of care over this period. RESULTS Thirty five patients were identified with thirty three patients eligible for analysis. Median age was 35 years (range, 19-52). Fourteen patients were kept under active surveillance, eleven patients received adjuvant carboplatin and eight patients received adjuvant radiation to para-aortic chain. Five-year OS was 100% for all patients regardless post-operative approach. Five-year DFS was 100% for patients who received adjuvant chemotherapy or radiotherapy versus 93% for patients who were kept under active surveillance (p=0.03). CONCLUSION Clinical stage I seminoma is a favorable disease entity with favorable disease related outcomes regardless post-operative approach. Active surveillance is reasonable and safe given equal survival to active treatment.
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Affiliation(s)
- Manar Mahmoud Sayed
- Department of Radiation Oncology, National Cancer Institute, Cairo University.
| | - Azza Mohamad Nasr
- Department of Radiation Oncology, National Cancer Institute, Cairo University.
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16
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Abstract
Testicular cancer is a curable cancer. The success of physicians in curing the disease is underpinned by multidisciplinary advances. Cisplatin-based combination chemotherapy and the refinement of post-chemotherapy surgical procedures and diagnostic strategies have greatly improved long term survival in most patients. Despite such excellent outcomes, several controversial dilemmas exist in the approaches to clinical stage I disease, salvage chemotherapy, post-chemotherapy surgical procedures, and implementing innovative imaging studies. Relapse after salvage chemotherapy has a poor prognosis and the optimal treatment is not apparent. Recent research has provided insight into the molecular mechanisms underlying cisplatin resistance. Phase 2 studies with targeted agents have failed to show adequate efficacy; however, our understanding of cisplatin resistant disease is rapidly expanding. This review summarizes recent advances and discusses relevant issues in the biology and management of testicular cancer.
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Affiliation(s)
- Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, National Cancer Institute, Bratislava, Slovakia
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown University, Lifespan Academic Medical Center, Providence, RI, USA
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17
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Bastos DA, Gongora ABL, Dzik C, Jardim DL, Piva M, Carcano FM, Bertollo G, Trindade K, Fontes MS, Soares A, Reinert T, De Cassia Costamilan R, Villarroel RU, Watarai G, Gazola AA, Preto DDA, Mutti H, Bonalumi Dos Santos M, Mariano RC, Binotto M, Carvalho MM, Oliveira VPDC, Gomes R, Rebelatto TF, Schutz FA, Smaletz O, Fay AP. Multicenter Database of Patients with Germ-Cell Tumors: A Latin American Cooperative Oncology Group Registry (LACOG 0515). Clin Genitourin Cancer 2022; 21:e104-e113. [PMID: 36509612 DOI: 10.1016/j.clgc.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Germ-cell tumors (GCTs) are the most common malignancy in young men. There is a paucity of data on GCTs in developing countries. LACOG 0515 study aimed to evaluate clinical characteristics and treatment outcomes in patients with GCTs from Brazilian cancer centers. MATERIALS AND METHODS This is a retrospective cohort study evaluating male patients diagnosed with GCTs from 2000 to 2018 in 13 Brazilian hospitals. We described baseline characteristics, progression-free survival (PFS), and overall survival (OS). RESULTS A total of 1232 patients were included, with a median age of 30 years. Histology was seminoma in 47.1% and non-seminoma GCT (NSGCT) in 52.9%. The primary tumor site was testis in 96.5%. At diagnosis, clinical stage I was present in 68.1% and 34.7% and clinical stages IS/II/III in 31.9% and 65.2% of patients with seminoma and NSCGT, respectively. Following orchiectomy, 55.2% of patients with clinical stage I were managed with surveillance. The 5-year disease-free survival rates among patients with stage I were 98.0% in seminoma and 92.3% in NSGCT, with 5-year OS of 99.6% and 97.6%, respectively. Among patients with advanced disease (IS, II, and III), the 5-year PFS were 88.7% in seminoma and 68.7% in NSGCT, with 5y-OS of 97.6% and 82.8%, respectively. CONCLUSION This is the largest Brazilian cohort of GCTs. Our results show a high rate of adjuvant chemotherapy in patients with clinical stage I. Although our data demonstrate slightly inferior PFS compared with the International Germ Cell Cancer Collaborative Group and other contemporary series, the OS rates were similar.
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Affiliation(s)
- Diogo A Bastos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Aline Bobato Lara Gongora
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil
| | - Carlos Dzik
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Denis Leonardo Jardim
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | - Karine Trindade
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Oncocentro, Fortaleza, Brazil
| | | | - Andrey Soares
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital Israelita Albert Einstein, São Paulo, Brazil; Centro Paulista de Oncologia/Oncoclínicas- São Paulo, São Paulo, Brazil
| | - Tomas Reinert
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias Do Sul, Brazil
| | | | | | - Gabriel Watarai
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Antonia Angeli Gazola
- Hospital São Lucas PUC-RS, Porto Alegre, Brazil; PUC-RS School of Medicine, Porto Alegre, Brazil
| | | | - Haila Mutti
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | - Monique Binotto
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias Do Sul, Brazil
| | | | | | - Rafaela Gomes
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Andre P Fay
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Hospital São Lucas PUC-RS, Porto Alegre, Brazil; PUC-RS School of Medicine, Porto Alegre, Brazil
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18
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Papachristofilou A, Bedke J, Hayoz S, Schratzenstaller U, Pless M, Hentrich M, Krege S, Lorch A, Aebersold DM, Putora PM, Berthold DR, Zihler D, Zengerling F, Dieing A, Mueller AC, Schaer C, Biaggi C, Gillessen S, Cathomas R. Single-dose carboplatin followed by involved-node radiotherapy for stage IIA and stage IIB seminoma (SAKK 01/10): a single-arm, multicentre, phase 2 trial. Lancet Oncol 2022; 23:1441-1450. [PMID: 36228644 DOI: 10.1016/s1470-2045(22)00564-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Standard treatment options for patients with stage IIA or stage IIB seminoma include either para-aortic and pelvic radiotherapy or three to four cycles of cisplatin-based combination chemotherapy. These options result in 3-year progression free survival rates of at least 90%, but bear risks for acute and late toxic effects, including secondary malignancies. We tested a novel approach combining de-escalated chemotherapy with de-escalated involved node radiotherapy, with the aim of reducing toxicity while preserving efficacy. METHODS In the single-arm, multicentre, phase 2 SAKK 01/10 trial, patients with stage IIA or IIB classic seminoma (either at primary diagnosis or at relapse during active surveillance for stage I) were enrolled at ten centres of the Swiss Group for Clinical Cancer Research and ten centres of the German Testicular Cancer Study Group. WHO performance status 0-2, age 18 years or older, and adequate bone marrow and kidney function were required for eligibility. Treatment comprised one cycle of carboplatin (area under the curve 7) followed by involved-node radiotherapy (30 Gy in 15 fractions for stage IIA disease and 36 Gy in 18 fractions for stage IIB disease). The primary endpoint was 3-year progression-free survival. Efficacy analyses were done on the full analysis set, which comprised all patients who signed the informed consent, were registered in the trial, initiated trial treatment, and met all medically relevant inclusion or exclusion criteria. Safety was assessed in all patients who were treated at least once with one of the trial treatments. The study is ongoing but no longer recruiting, and is registered with Clinicaltrials.gov, NCT01593241. FINDINGS Between Oct 18, 2012, and June 22, 2018, 120 patients were registered in the study. 116 patients were eligible and started treatment according to the study protocol (46 patients with stage IIA disease and 70 with stage IIB disease). After a median follow-up of 4·5 years (IQR 3·9-6·0), 3-year progression-free survival was 93·7% (90% CI 88·5-96·6). With a target progression-free survival of 95% at 3 years, the primary endpoint was not met. Acute treatment-related adverse events of any grade were noted in 58 (48%) of 116 patients, and grade 3 or 4 treatment-related adverse events occurred in the form of neutropenia in five (4%) patients, thrombocytopenia in three (3%) patients, and vomiting in one (1%) patient. No treatment-related deaths and no late treatment-related adverse events were reported. Serious adverse events were reported in five (4%) of 116 patients (one transient creatinine increase and four second primary tumours). INTERPRETATION Despite the fact that the primary endpoint was not met, we observed favourable 3-year progression-free survival with single-dose carboplatin area under the curve 7 and involved-node radiotherapy, with minimal toxic effects. Our findings might warrant discussion with patients about the SAKK 01/10 regimen as an alternative to standard-of-care treatment, but more research on this strategy is needed. FUNDING Swiss State Secretariat for Education, Research and Innovation and Rising Tide Foundation for Clinical Cancer Research.
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Affiliation(s)
| | - Jens Bedke
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - Stefanie Hayoz
- Competence Center of SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Miklos Pless
- Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Susanne Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Anja Lorch
- Department of Urology, University Hospital Duesseldorf, Duesseldorf, Germany; Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel-M Aebersold
- Department of Radiation Oncology, University Hospital of Bern, Bern, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Dominik-R Berthold
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Deborah Zihler
- Department of Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Annette Dieing
- Department of Internal Medicine, Hematology and Oncology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Corinne Schaer
- Competence Center of SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Christine Biaggi
- Competence Center of SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Silke Gillessen
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Richard Cathomas
- Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
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19
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Lesko P, Chovanec M, Mego M. Biomarkers of disease recurrence in stage I testicular germ cell tumours. Nat Rev Urol 2022; 19:637-658. [PMID: 36028719 DOI: 10.1038/s41585-022-00624-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/09/2022]
Abstract
Stage I testicular cancer is a disease restricted to the testicle. After orchiectomy, patients are considered to be without disease; however, the tumour is prone to relapse in ~4-50% of patients. Current predictive markers of relapse, which are tumour size and invasion to rete testis (in seminoma) or lymphovascular invasion (in non-seminoma), have limited clinical utility and are unable to correctly predict relapse in a substantial proportion of patients. Adjuvant therapeutic strategies based on available biomarkers can lead to overtreatment of 50-85% of patients. Discovery and implementation of novel biomarkers into treatment decision making will help to reduce the burden of adjuvant treatments and improve patient selection for adjuvant therapy.
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Affiliation(s)
- Peter Lesko
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Chovanec
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia.
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Kaufmann E, Antonelli L, Albers P, Cary C, Gillessen Sommer S, Heidenreich A, Oing C, Oldenburg J, Pierorazio PM, Stephenson AJ, Fankhauser CD. Oncological Follow-up Strategies for Testicular Germ Cell Tumours: A Narrative Review. EUR UROL SUPPL 2022; 44:142-149. [PMID: 36106144 PMCID: PMC9465095 DOI: 10.1016/j.euros.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Luca Antonelli
- Department of Urology, Luzerner Kantonssspital, Lucerne, Switzerland
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Clint Cary
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Silke Gillessen Sommer
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Faculty of Biosciences, USI University, Lugano, Switzerland
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Christoph Oing
- Sir Bobby Robson Cancer Trials Research Centre, Department of Cancer Services, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital and Medical Faculty of University of Oslo, Oslo, Norway
| | - Phillip Martin Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Christian Daniel Fankhauser
- University of Zurich, Zurich, Switzerland
- Department of Urology, Luzerner Kantonssspital, Lucerne, Switzerland
- Corresponding author. Department of Urology, Luzerner Kantonsspital, Spitalstrasse 6000, 16 Lucerne, Switzerland.
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21
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Total embedding of spermatic cord and hilar soft tissue in orchiectomy for seminoma: does the extensive sampling improve pathologic risk factors? Virchows Arch 2022; 481:695-701. [PMID: 35776192 DOI: 10.1007/s00428-022-03370-z] [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: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens. The aim of our study is to find the most informative gross sampling method for orchiectomy specimens. We performed the extensive sampling of 88 radical orchiectomy specimens embedding in their entirety testicular hilum, rete testis, hilar soft tissue, and spermatic cord. We examined the impact of this procedure on tumor stage, prognostic parameters (lymphovascular invasion and infiltration of rete testis, epididymis, tunica vaginalis, and spermatic cord), and their relationship with recurrence. Eighty-eight seminomas from 88 radical orchiectomies were sampled. Seventy-seven cases (87.5%) presented as clinical stage I and 11 cases (12.5%) as clinical stage II. The follow-up period range was 18-54 months and 82 patients (93.2%) had a minimum of 2-year follow-up. Tumor size ranged from 0.4 to 16 cm (mean 3.6) requiring a mean of 7.1 sections for entire tumoral sampling. Epididymis required 2 to 8 sections (mean 3.3), and hilum and hilar soft tissues 2 to 9 sections (mean 3.4). Epididymal infiltration and lymphovascular invasion resulted significant at multivariate analysis generating a receiver operating characteristic (ROC) curve with area under curve of 0.778. All the other parameters (except for pagetoid rete testis infiltration) were significant to predict metastasis only at univariate analysis. Extensive sampling of radical orchiectomy specimens does not improve the accuracy of staging in pure seminomas. Lymphovascular invasion and epididymal infiltration are useful to predict metastasis.
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22
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Papachristofilou A, Zimmermann F. [Malignant testicular neoplasms in the cisplatin era: causes of death and mortality in a cohort study]. Strahlenther Onkol 2022; 198:862-865. [PMID: 35581422 DOI: 10.1007/s00066-022-01957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alexandros Papachristofilou
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
| | - Frank Zimmermann
- Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
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Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA, De Giorgi U, Haugnes HS, Huddart RA, Leão R, Sohaib A, Gillessen S, Powles T. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:362-375. [PMID: 35065204 DOI: 10.1016/j.annonc.2022.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - D M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London; Barts Health NHS Trust, London, UK
| | - C Bokemeyer
- Department of Oncology, Hematology, Bone Marrow Transplantation with section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M A Climent
- Fundacion Instituto Valenciano de Oncología, València, Spain
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST),'Dino Amadori', Meldola, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway and UiT-The Arctic University, Tromsoe, Norway
| | - R A Huddart
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, UK
| | - R Leão
- Department of Urology, Hospital de Braga, Hospital CUF Coimbra, Faculty of Medicine University of Coimbra, Coimbra, Portugal
| | - A Sohaib
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona; Faculty of Biomedical Sciences, USI, Lugano, Switzerland; Division of Cancer Medicine, University of Manchester, Manchester
| | - T Powles
- Barts Health NHS Trust, London, UK
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TONYALI Ş. Testis Kanseri Tedavisinde Güncel Yaklaşım. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.960776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gedye C, Navani V. Find the path of least resistance: Adaptive therapy to delay treatment failure and improve outcomes. Biochim Biophys Acta Rev Cancer 2022; 1877:188681. [PMID: 35051527 DOI: 10.1016/j.bbcan.2022.188681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/01/2022] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
Cytotoxic chemotherapy and targeted therapies help people with advanced cancers, but for most, treatment fails. Cancer heterogeneity is one cause of treatment failure, but also suggests an opportunity to improve outcomes; reconceptualising cancer therapy as an ecological problem offers the strategy of adaptive therapy. If an agent is active against a patient's cancer, instead of traditional continuous dosing at the maximum tolerated dose until treatment failure, the patient and their oncologist may instead choose to pause treatment as soon as the cancer responds. When tumour burden increases, the cancer is rechallenged with the same agent in hope of delivering another response, ideally before symptoms occur or quality-of-life is impacted. These 'loops' of 'pause/restart' allows an active treatment to be used strategically, to delay the development of evolutionary selection within the cancer, delaying the onset of treatment resistance, controlling the cancer for longer. Modelling predicts patients can navigate several 'loops', potentially increasing the utility of an active treatment by multiples, and early trials suggest at least doubling of progression-free survival. In this narrative review we confront how cancer heterogeneity limits treatment effectiveness, re-examine cancer as an ecological problem, review the data supporting adaptive therapy and outline the challenges and opportunities faced in clinical practice to implement this evolutionary concept. In an era where multiple novel active anti-neoplastic agents are being used with ancient inflexibile maximum tolerated dose for maximum duration approaches, adaptive dosing offers a personalised, n = 1 approach to cancer therapy selection.
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Affiliation(s)
- Craig Gedye
- Calvary Mater Newcastle, Waratah 2298, NSW, Australia; Clinical Trial Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; School of Medicine and Public Health University of Newcastle, NSW, Australia.
| | - Vishal Navani
- Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada.
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26
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Testicular germ cell tumours' clinical stage I: comparison of surveillance with adjuvant treatment strategies regarding recurrence rates and overall survival-a systematic review. World J Urol 2022; 40:2889-2900. [PMID: 36107211 PMCID: PMC9712330 DOI: 10.1007/s00345-022-04145-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/23/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Testicular germ cell tumours (GCTs) represent the most common malignancy in young adult males with two thirds of all cases presenting with clinical stage I (CSI). Active surveillance is the management modality mostly favoured by current guidelines. This systematic review assesses the treatment results in CSI patients concerning recurrence rate and overall survival in non-seminoma (NS) and pure seminoma (SE) resulting from surveillance in comparison to adjuvant strategies. METHODS/SYSTEMATIC REVIEW We performed a systematic literature review confining the search to most recent studies published 2010-2021 that reported direct comparisons of surveillance to adjuvant management. We searched Medline and the Cochrane Library with additional hand-searching of reference lists to identify relevant studies. Data extraction and quality assessment of included studies were performed with stratification for histology (NS vs. SE) and treatment modalities. The results were tabulated and evaluated with descriptive statistical methods. RESULTS Thirty-four studies met the inclusion criteria. In NS patients relapse rates were 12 to 37%, 0 to 10%, and 0 to 11.8% for surveillance, chemotherapy and for retroperitoneal lymph node dissection (RPLND) while overall survival rates were 90.7-100%, 91.7-100%, and 97-99.1%, respectively. In SE CSI, relapse rates were 0-22.3%, 0-5%, and 0-12.5% for surveillance, radiotherapy, chemotherapy, while overall survival rates were 84.1-98.7%, 83.5-100%, and 92.3-100%, respectively. CONCLUSION In both histologic subgroups, active surveillance offers almost identical overall survival as adjuvant management strategies, however, at the expense of higher relapse rates. Each of the management strategies in CSI GCT patients have specific merits and shared-decision-making is advised to tailor treatment.
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Abstract
PURPOSE OF REVIEW Testicular cancer is the most common solid malignancy amongst young men, and a large proportion present with stage I disease. The options for management following radical orchiectomy are multifold. We review here approaches to treatment in this setting, providing an update on recent publications. RECENT FINDINGS At Princess Margaret Cancer Centre, we maintain a nonrisk adapted active surveillance approach. With a dedicated surveillance program using low-dose computed tomography imaging, patients are appropriately identified early for treatment on relapse. There are ongoing investigations into minimizing toxicities of treatments for relapse, and in particular, retroperitoneal lymph node dissection (RPLND) presents an attractive alternative. This, though, remains investigational in the setting of seminoma. SUMMARY Testicular cancer is a highly curable malignancy. In stage I disease, an active surveillance approach following radical orchiectomy is preferred, irrespective of risk-profile. This approach serves to limit the toxicity of adjuvant treatment in a significant proportion of patients, while maintaining excellent survival outcomes.
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Affiliation(s)
- Jerusha Padayachee
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Roderick Clark
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Clinical characteristics, treatment patterns and relapse in patients with clinical stage IS testicular cancer. World J Urol 2021; 40:327-334. [PMID: 34854948 PMCID: PMC8921055 DOI: 10.1007/s00345-021-03889-x] [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] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Clinical stage I (CSI) testicular germ cell tumors (TGCT) represents disease confined to the testis without metastasis and CSIS is defined as persistently elevated tumor markers (TM) after orchiectomy, indicating subclinical metastatic disease. This study aims at assessing clinical characteristics and oncological outcome in CSIS. Methods Data from five tertiary referring centers in Germany were screened. We defined correct classification of CSIS according to EAU guidelines. TM levels, treatment and relapse-free survival were assessed and differences between predefined groups (chemotherapy, correct/incorrect CSIS) were analyzed with Fisher’s exact and Chi-square test. Results Out of 2616 TGCT patients, 43 (1.6%) were CSIS. Thereof, 27 were correctly classified (cCSIS, 1.03%) and 16 incorrectly classified (iCSIS). TMs that defined cCSIS were in 12 (44.4%), 10 (37%), 3 (11.1%) and 2 (7.4%) patients AFP, ß-HCG, AFP plus ß-HCG and LDH, respectively. In the cCSIS group, six patients were seminoma and 21 non-seminoma. Treatment consisted of active surveillance, carboplatin-mono AUC7 and BEP (bleomycin, etoposide and cisplatin). No difference between cCSIS and iCSIS with respect to applied chemotherapy was found (p = 0.830). 5-year relapse-free survival was 88.9% and three patients (11%) in the cCSIS group relapsed. All underwent salvage treatment (3xBEP) with no documented death. Conclusion Around 1% of all TGCT were classified as cCSIS patients. Identification of cCSIS is of critical importance to avoid disease progression and relapses by adequate treatment. We report a high heterogeneity of treatment patterns, associated with excellent long-term survival irrespective of the initial treatment approach.
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Davila Dupont D, Motola Kuba D, Alcantara Velarde TDLM, Martinez Castaneda EA, Dorantes Heredia R, Ruiz Morales JM. Impact of Testicular Germ Cell Tumor Laterality on Recurrence-Free Survival in the Mexican Population. World J Oncol 2021; 12:173-177. [PMID: 34804280 PMCID: PMC8577600 DOI: 10.14740/wjon1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, the prognostic value of laterality for testicular germ cell tumors remains unknown. Herein, we describe this prognostic factor in the Mexican population. Methods A retrospective single-center study that included 37 patients with primary testicular germ cell tumors was conducted. Primary outcome was recurrence-free survival (RFS) at 2 years. Secondary outcomes were RFS by histology, progression-free survival by laterality, and 2-year overall survival. Results Thirty-seven patients were included, of which five showed relapses. By laterality, the 2-year RFS rate was 100% for left tumors and 77.3% for right tumors, with a trend toward statistical significance (P = 0.058). By histology, the RFS rate was higher for seminomas than non-seminomas (89% vs. 83%, respectively) without this difference being statistically significant. Progression-free survival was higher for right tumors than left tumors (91% vs. 80%, respectively) but without reaching statistical significance. The overall survival rate for the entire cohort was 94.5%. Conclusions Our study shows that patients with primary germ cell tumors of the right testicle have a higher risk of recurrence than those with primary germ cell tumors of the left testicle, with a trend toward statistical significance.
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30
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Hentrich MU, Bower M, Daugaard G, Dieing A, Bickel M, Berretta M, Lesmeister F, Jurinovic V, Stoehr A, Heinzelbecker J, Krznaric I, Dieckmann KP, Necchi A, Maroto Rey P, Rockstroh JK, Brito M, Pfister D, Hoffmann C. Outcomes of men with HIV and germ cell cancer: Results from an international collaborative study. Cancer 2021; 128:260-268. [PMID: 34592009 DOI: 10.1002/cncr.33928] [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: 06/06/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have shown that men with HIV and germ cell cancer (HIV-GCC) have inferior overall survival (OS) in comparison with their HIV-negative counterparts. However, little information is available on treatments and outcomes of HIV-GCC in the era of combination antiretroviral therapy (cART). METHODS This study examined men living with HIV who were 18 years old or older and had a diagnosis of histologically proven germ cell cancer (GCC). The primary outcomes were OS and progression-free survival (PFS). RESULTS Data for 89 men with a total of 92 HIV-GCCs (2 synchronous GCCs and 1 metachronous bilateral GCC) were analyzed; among them were 64 seminomas (70%) and 28 nonseminomas (30%). The median age was 36 years, the median CD4 T-cell count at GCC diagnosis was 420 cells/µL, and 77% of the patients on cART had an HIV RNA load < 500 copies/mL. Stage I disease was found in 44 of 79 gonadal GCCs (56%). Among 45 cases with primary disseminated GCC, 78%, 18%, and 4% were assigned to the good-, intermediate-, and poor-prognosis groups, respectively, of the International Germ Cell Cancer Collaborative Group. Relapses occurred in 14 patients. Overall, 12 of 89 patients (13%) died. The causes of death were refractory GCC (n = 5), an AIDS-defining illness (n = 3), and other causes (n = 4). After a median follow-up of 6.5 years, the 5- and 10-year PFS rates were 81% and 73%, respectively, and the 5- and 10-year OS rates were 91% and 85%, respectively. CONCLUSIONS The 5- and 10-year PFS and OS rates of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients. LAY SUMMARY Men living with HIV are at increased risk for germ cell cancer (GCC). Previous studies have shown that the survival of men with HIV-associated germ cell cancer (HIV-GCC) is poorer than the survival of their HIV-negative counterparts. This study examined the characteristics, treatments, and outcomes of 89 men with HIV-GCC in the era of effective combination antiretroviral therapies. The long-term outcomes of men with HIV-GCC were similar to those reported for men with HIV-negative GCC. Patients with HIV-GCC should be managed identically to HIV-negative patients.
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Affiliation(s)
- Marcus Ulrich Hentrich
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Mark Bower
- National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, United Kingdom
| | - Gedske Daugaard
- Department of Oncology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Annette Dieing
- Department of Hematology and Oncology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Massimiliano Berretta
- National Cancer Institute, Aviano, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Florian Lesmeister
- Department of Hematology and Oncology, Red Cross Hospital, University of Munich, Munich, Germany
| | - Vindi Jurinovic
- Institute of Biometrics and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
| | | | - Julia Heinzelbecker
- Department of Urology and Pediatric Urology, Saarland University Medical Center and Saarland University, Homburg, Germany
| | | | | | - Andrea Necchi
- IRCCS San Raffaele Hospital and Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pablo Maroto Rey
- Department of Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Margarida Brito
- Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Christian Hoffmann
- ICH Study Center, Hamburg, Germany.,University Hospital of Schleswig Holstein, Kiel, Germany
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[Testicular and penile cancer-survival and quality of life : New guideline and network for second opinions]. Urologe A 2021; 60:847-853. [PMID: 34232324 DOI: 10.1007/s00120-021-01573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 10/20/2022]
Abstract
Testicular cancer occupies a special position in several respects. Although it belongs to the group of rare tumors, which is why extensive experience in treating this tumor can not be guaranteed, interdisciplinary experts collaboration and the consequent implementation of clinical studies have resulted in standardized treatment recommendations. Because testicular cancer is one of the most curable cancers, long-term toxicity and treatment sequelae are of special importance. In the early stages, toxicity could be reduced by minimizing therapy to the extent possible, but without decreasing treatment success. Nevertheless, treatment is still controversially discussed, especially concerning treatment of stage I disease. Finally particular focus should be paid to non-germinal tumors which are even more rare, but partly also more dangerous. Therefore known facts should be made available for the broad medical community. In penile cancer, which is also a very rare tumor entity, organ-sparing surgery and consequent invasive lymph node staging are mandatory.
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Conduit C, Tran B. Improving outcomes in germ cell cancers using miRNA. Ther Adv Med Oncol 2021; 13:17588359211027826. [PMID: 34262617 PMCID: PMC8252353 DOI: 10.1177/17588359211027826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Owing to advances in treatment paradigms across the last five decades, testicular cancer is now eminently curable. However, current serum tumour and imaging biomarkers lack adequate sensitivity, specificity, and predictive value. Subsequently, their utility in detecting active malignancy and informing treatment decisions is minimal in a large proportion of men with testicular cancer. Micro-ribonucleic acids (miRNA), pertinently miR-371a-3p, offer a new tool, which based on early data, appears to fill many of the gaps that existing biomarkers leave. This paper reviews the evolution of the technology, potential limitations, and discusses the clinical relevance of miRNA as it moves towards the clinic.
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Affiliation(s)
- Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett St, Melbourne, VIC 8006, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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Heinzelbecker J, Ruf C. [non-metastasised clincial stage I testicular germ cell tumours : Patient information, suitability and limitations of surveillance]. Urologe A 2021; 60:854-861. [PMID: 34170358 DOI: 10.1007/s00120-021-01565-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surveillance is the most frequently used treatment option in testicular germ cell tumour (TGCT) patients in nonmetastasised clinical stage I (cSI). OBJECTIVES Presentation of indications for surveillance, the process of individual patient's advice and the limitations of surveillance. MATERIALS AND METHODS An overview of the current literature is given, including basic research, systemic reviews and expert recommendations. Basic principles are illustrated by case reports. RESULTS The risk of progression for cSI TGCT patients under surveillance is 5-30% for seminomas and 15-50% for nonseminomas. Surveillance is the preferred treatment option in seminoma and low-risk nonseminoma without lymphovascular invasion. Patients should be informed concerning the individual risk of progression, the possibilities of adjuvant therapy, side effects of adjuvant therapy, the kind of therapy in case of progression and the cure rate. A high risk of progression, psychological issues and malcompliance are important limitations of surveillance. CONCLUSION By thoroughly considering the limitations of surveillance, cSI TGCT patients can be safely treated with surveillance.
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Affiliation(s)
- Julia Heinzelbecker
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Kirrbergerstr. 100, 66424, Homburg/Saar, Deutschland.
| | - Christian Ruf
- Klinik für Urologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
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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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Rizzo M, Ongaro L, Claps F, Ghassempour D, Verzotti E, Migliozzi F, Boltri M, Pavan N, Garaffa G, Bucci S, Umari P, Trombetta C, Liguori G. Analysis of clinical utility of abdominopelvic computed tomography in the follow-up of Stage I seminoma: a single center evaluation. Minerva Urol Nephrol 2021; 73:84-89. [PMID: 31833335 DOI: 10.23736/s2724-6051.19.03562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Abdominopelvic computed tomography (CT) is widely used in the follow-up of seminoma patients after radical orchidectomy. The aim of this study was to evaluate the clinical utility of abdominopelvic computed tomography in the follow-up of patients with Stage I seminoma. METHODS The pathological reports of all patients that have undergone radical orchidectomy in our tertiary referral center between January 2002 and January 2018 have been retrospectively reviewed. All patients with Stage I seminoma and negative serum tumor markers after radical orchidectomy were included. Patients with follow-up shorter than 12 months were excluded. Surveillance records of every patient were reviewed with regard to abdominopelvic imaging. RESULTS Of the 133 patients who have undergone radical orchidectomy in our center, 55 had Stage I pure seminoma with normal levels of serum tumor markers after surgery. Two patients were excluded as the follow-up was inadequate. Mean follow-up was 63.2 months (IQR: 30-73). The results of 211 abdominopelvic CTs performed as part of the follow-up were reviewed. Two (3,7%) patients developed recurrence; one consisted of a scrotal lump and was diagnosed with ultrasonography (US) while the second appeared as paraaortic nodal metastasis and was diagnosed with abdominopelvic CT. The recurrence was successfully treated in both patients. A single abdominopelvic CT was useful for the detection of recurrent disease in our entire study population. No cancer specific death has been reported in the study population. CONCLUSIONS Follow-up schedules for Stage I seminoma expose patients to potential risks of radiation-induced tumors, emotional distress and represent a significant burden for the healthcare system. The current series suggests that a better risk adapted patient-tailored follow-up program is needed in order to avoid unnecessary investigations.
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Affiliation(s)
- Michele Rizzo
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy -
| | - Luca Ongaro
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Dario Ghassempour
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Enrica Verzotti
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Francesca Migliozzi
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Matteo Boltri
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giulio Garaffa
- The Institute of Urology, University College London Hospitals, London, UK
| | - Stefano Bucci
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Paolo Umari
- Department of Surgery, Clinic of Urology, University of Eastern Piedmont, Novara, Italy
| | - Carlo Trombetta
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Medicine, Surgery and Health Sciences, Clinic of Urology, University of Trieste, Trieste, Italy
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Blok JM, Groot HJ, Huele EH, de Wit R, Horenblas S, Nuver J, Groenewegen G, Bosch JR, Witjes JA, Tromp JM, de Brouwer PJ, van den Berg HA, Vanneste BG, Smilde TJ, Aarts MJ, Gietema JA, Meijer RP, Schaapveld M. Dose-Dependent Effect of Platinum-Based Chemotherapy on the Risk of Metachronous Contralateral Testicular Cancer. J Clin Oncol 2021; 39:319-327. [DOI: 10.1200/jco.20.02352] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with testicular germ cell tumor (TGCT) are at increased risk of developing a contralateral TGCT (CTGCT). Although some studies suggest that prior treatment with platinum-based chemotherapy affects CTGCT risk, a relationship between CTGCT risk and platinum dose has not previously been assessed. We analyzed the association between the number of platinum-based chemotherapy cycles and CTGCT risk. PATIENTS AND METHODS The risk of developing a metachronous CTGCT was evaluated in a nationwide cohort of 4,755 patients diagnosed with primary TGCT in the Netherlands between 1989 and 2007. Standardized incidence ratios were computed to compare CTGCT incidence with expected TGCT on the basis of TGCT incidence in the general population. The cumulative incidence of CTGCT was estimated in the presence of death as competing risk. The effect of treatment with platinum-based chemotherapy on CTGCT risk was assessed using multivariable Cox proportional hazards regression models. RESULTS CTGCT was diagnosed in 136 patients (standardized incidence ratio, 14.6; 95% CI, 12.2 to 17.2). The cumulative incidence increased up to 20 years after primary diagnosis, reaching 3.4% (95% CI, 2.8% to 4.0%) after 20 years of follow up. The risk of developing a CTGCT decreased with age (hazard ratio [HR], 0.93; 95% CI, 0.90 to 0.96), was lower after nonseminomatous germ cell tumor (HR, 0.58; 95% CI, 0.35 to 0.96) and decreased with every additional cycle of chemotherapy (HRper cycle, 0.74; 95% CI, 0.64 to 0.85). CONCLUSION Approximately one in every 30 survivors of TGCT will develop a CTGCT, with CTGCT incidence increasing up to 20 years after a primary TGCT. Treatment with platinum-based chemotherapy shows a dose-dependent inverse association with CTGCT risk.
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Affiliation(s)
- Joost M. Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harmke J. Groot
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eline H. Huele
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Hospital, Rotterdam, the Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J.L.H. Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacqueline M. Tromp
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Peter J.M. de Brouwer
- Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, Maastricht, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Shamash J, Ansell W, Alifrangis C, Thomas B, Wilson P, Stoneham S, Mazhar D, Warren A, Barrett T, Alexander S, Rudman S, Lockley M, Berney D, Sahdev A. The impact of a supranetwork multidisciplinary team (SMDT) on decision-making in testicular cancers: a 10-year overview of the Anglian Germ Cell Cancer Collaborative Group (AGCCCG). Br J Cancer 2021; 124:368-374. [PMID: 32989229 PMCID: PMC7853071 DOI: 10.1038/s41416-020-01075-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The germ cell supranetwork multidisciplinary team (SMDT) for the Anglian Network covers a population of 7.5 million. METHODS We reviewed 10 years of SMDT discussion and categorised them into five domains ((1) overall outcome, (2) chemotherapy regimens-untreated disease and salvage therapy, (3) radiology, (4) pathology and (5) complex cases) to assess the impact of the SMDT. RESULTS A total of 2892 new cases were reviewed. In the first 5 years, patients with good prognosis disease had poorer survival in low-volume vs high-volume centres (87.8 vs 95.3, p = 0.02), but the difference was no longer significant in the last 5 years (93.3 vs 95.1, p = 0.30). Radiology review of 3206 scans led to rejection of the diagnosis of progression in 26 cases and a further 10 cases were down-staged. There were 790 pathology reviews by two specialised uropathologists, which lead to changes in 75 cases. 18F-fluorodeoxyglucose (18FDG) PET-CT was undertaken during this time period but did not help to predict who would have viable cancer. A total of 26 patients with significant mental health issues who were unable to give informed consent were discussed. CONCLUSION SMDT working has led to an improvement in outcomes and refining of treatment in patients with germ cell tumours.
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Affiliation(s)
| | | | | | - Benjamin Thomas
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Anne Warren
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tristan Barrett
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Susanna Alexander
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Sarah Rudman
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michelle Lockley
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
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Murez T, Fléchon A, Savoie PH, Rocher L, Camparo P, Morel-Journel N, Ferretti L, Méjean A. [French ccAFU guidelines - update 2020-2022: testicular germ cell tumors]. Prog Urol 2020; 30:S280-S313. [PMID: 33349427 DOI: 10.1016/s1166-7087(20)30754-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE - To update French guidelines concerning testicular germ cell cancer. MATERIALS AND METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer and treatments toxicities. Level of evidence was evaluated. RESULTS - Testicular Germ cell tumor diagnosis is based on physical examination, biology tests (serum tumor markers AFP, hCGt, LDH) and radiological assessment (scrotal ultrasound and chest, abdomen and pelvis computerized tomography). Total inguinal orchiectomy is the first-line treatment allowing characterization of the histological type, local staging and identification of risk factors for micrometastases. In case of several therapeutic options, one must inform his patient balancing risks and benefits. Surveillance is usually chosen in stage I seminoma compliant patients as the evolution rate is low between 15 to 20%. Carboplatin AUC7 is an alternative option. Radiotherapy indication should be avoided. In stage I non seminomatous patients, either surveillance or risk-adapted strategy can be applied. Staging retroperitoneal lymphadenectomy has restricted indications. Metastatic germ cell tumors are usually treated by PEB chemotherapy according to IGCCCG prognostic classification. Lombo-aortic radiotherapy is still a standard treatment for stage IIA. Residual masses should be evaluated by biological and radiological assessment 3 to 4 weeks after the end of chemotherapy. Retroperitoneal lymphadenectomy is advocated for every non seminomatous residual mass more than one cm. 18FDG uptake should be evaluated for each seminoma residual mass more than 3 cm. CONCLUSIONS - A rigorous use of classifications is mandatory to define staging since initial diagnosis. Applying treatments based on these classifications leads to excellent survival rates (99% in CSI, 85% in CSII+).
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Affiliation(s)
- T Murez
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU Lapeyronie, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France.
| | - A Fléchon
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P-H Savoie
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France
| | - L Rocher
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - P Camparo
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - N Morel-Journel
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Chandran EA, Chindewere A, North R, Jameson MB. Two cycles of adjuvant carboplatin for clinical stage 1 testicular seminoma in New Zealand centres: A retrospective analysis of efficacy and long-term events. Cancer Rep (Hoboken) 2020; 4:e1310. [PMID: 33103860 PMCID: PMC8451369 DOI: 10.1002/cnr2.1310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023] Open
Abstract
Background Adjuvant carboplatin reduces relapse risk in clinical stage 1 (CS1) seminoma, though there is a paucity of long‐term safety data. Aim Our objective was to report long‐term outcomes of two cycles of adjuvant carboplatin dosed at area under the time–concentration curve (AUC) of 7. Methods and results We performed a retrospective analysis on treatment and outcomes of patients with CS1 seminoma who received adjuvant carboplatin from 2000 to 2016 at our centres in the Midland Region, New Zealand. Of 159 patients, median age 39 years, 153 received two cycles of carboplatin: 147 dosed at AUC7 and 6 at AUC6. Six patients had one cycle of carboplatin AUC7. One patient relapsed at 22 months and died of bleomycin pneumonitis 2 months after achieving a complete response with BEP chemotherapy. Neither RTI (present in 21.3%) nor tumor size >4 cm (in 43.3%) was predictive of relapse. Median follow‐up was 106 months. At 15 years, outcomes were: relapse‐free survival 99.4%, overall survival 91.4%, disease‐specific survival 100%, subsequent malignant neoplasm rate 7.6%, and second testicular germ cell tumor rate 3.85%. One patient had persistent grade 1 thrombocytopenia at 46 months. Conclusions These data add to the body of evidence that two cycles of carboplatin AUC7 is safe and effective adjuvant treatment for CS1 seminoma.
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Affiliation(s)
| | | | - Richard North
- Department of Oncology, Tauranga Hospital, Tauranga, New Zealand
| | - Michael B Jameson
- Department of Oncology, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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Abstract
PURPOSE OF REVIEW Approximately 30% of clinical stage 1 (CS1) nonseminomatous germ cell tumours (NSGCT) and 15-20% of CS1 seminoma relapse without adjuvant treatment. Despite this, the 5-year survival for CS1 is 99%. The purpose of this review is to assess if active surveillance should be standard for all patients with CS1 testis cancer independent of risk factors. RECENT FINDINGS Recent data from Princess Margaret Cancer Centre suggest a nonrisk-adapted surveillance approach avoids treatment in ∼70% of patients. Most relapse early at a median time of 7.4 months. The majority of relapses are confined to the retroperitoneum (66%) and only one modality of treatment is required: chemotherapy only in 61% and RPLND only in 73%. SUMMARY Surveillance is the preferred option and a safe proven strategy for the management of CS1 disease independent of risk factors. The prognosis for CS1 disease is excellent and the decision to offer surveillance or adjuvant treatment needs to highlight the treatment-related morbidity in an otherwise fit and healthy young man.
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41
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Cost-effectiveness Analysis of Non–risk-adapted Active Surveillance for Postorchiectomy Management of Clinical Stage I Seminoma. Eur Urol Focus 2020; 7:1409-1417. [DOI: 10.1016/j.euf.2020.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/08/2020] [Accepted: 06/19/2020] [Indexed: 11/20/2022]
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Nason GJ, Chung P, Warde P, Huddart R, Albers P, Kollmannsberger C, Booth CM, Hansen AR, Bedard PL, Einhorn L, Nichols C, Rendon RA, Wood LA, Jewett MAS, Hamilton RJ. Controversies in the management of clinical stage 1 testis cancer. Can Urol Assoc J 2020; 14:E537-E542. [PMID: 32569575 DOI: 10.5489/cuaj.6722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
| | - Robert Huddart
- The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Peter Albers
- Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Kollmannsberger
- British Columbia Cancer Agency Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Christopher M Booth
- Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
| | - Aaron R Hansen
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Philippe L Bedard
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lawrence Einhorn
- Department of Oncology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Craig Nichols
- Testicular Cancer Multidisciplinary Clinic, Virginia Mason Medical Center, Seattle, WA, United States
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Lori A Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Aparicio J, García Del Muro X, Maroto P, Terrasa J, Castellano D, Bastús R, Gumà J, Sagastibeltza N, Durán I, Ochenduszko S, Meana JA, García-Sánchez J, Arranz JA, Gironés R, Germà JR. Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group. Clin Transl Oncol 2020; 23:58-64. [PMID: 32462393 DOI: 10.1007/s12094-020-02393-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. METHODS We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. RESULTS No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin ± bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. CONCLUSION In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.
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Affiliation(s)
- J Aparicio
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
| | - X García Del Muro
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
| | - P Maroto
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Terrasa
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - D Castellano
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - R Bastús
- Hospital Universitari Mútua Terrassa, Terrassa, Spain
| | - J Gumà
- Hospital Universitari Sant Joan, URV, IISPV, Reus, Spain
| | | | - I Durán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - S Ochenduszko
- Hospital Universitario Doctor Peset, Valencia, Spain
| | - J A Meana
- Hospital General Universitario, Alicante, Spain
| | | | - J A Arranz
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - R Gironés
- Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain
| | - J R Germà
- Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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Aydin AM, Zemp L, Cheriyan SK, Sexton WJ, Johnstone PAS. Contemporary management of early stage testicular seminoma. Transl Androl Urol 2020; 9:S36-S44. [PMID: 32055484 PMCID: PMC6995845 DOI: 10.21037/tau.2019.09.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/26/2019] [Indexed: 12/28/2022] Open
Abstract
Therapy for early stage testicular seminoma has changed radically over the past several decades. Given high cure rates and clinical trials supporting less active therapy in most cases, close observation after radical orchiectomy is now considered standard of care for clinical stage (CS) IA/IB seminoma, with either radiation therapy (RT) or chemotherapy salvage options possible. For CS IIA/IIB seminoma characterized by non-bulky retroperitoneal lymph node involvement (≤5 cm in greatest dimension), RT or combination chemotherapy are the standard of care. Given high comparable survival rates, preventing treatment-related toxicity and second malignancy, and limiting quality of life deficits associated with intense treatment has gained much greater importance. Clinical trials are currently testing the feasibility of retroperitoneal lymph node dissection (RPLND) for low volume CS IIA/IIB metastatic testicular seminoma to this end. Likewise, one cycle of chemotherapy is being evaluated as an adjuvant approach to reduce recurrence rates in CS I disease with unfavorable risk factors. Moreover, recent genomic and molecular studies have recently identified novel signatures and a potential biomarker for testicular seminoma. In this review, we first summarize the evolution of early stage seminoma management and discuss the effectiveness and drawbacks of contemporary treatment strategies. We further outline future perspectives and potential challenges in management of early stage testicular seminoma.
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Affiliation(s)
- Ahmet Murat Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Salim K. Cheriyan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J. Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Peter A. S. Johnstone
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Werntz RP, Eggener SE. Defining risk of micrometastatic disease and tumor recurrence in patients with stage I testicular germ cell tumors. Transl Androl Urol 2020; 9:S31-S35. [PMID: 32055483 DOI: 10.21037/tau.2019.06.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is controversy in the management of patients with clinical stage I non-seminomatous germ cell tumor (NSGCT). Some experts recommend surveillance for all patients regardless of risk factors while others suggest a more risk-adapted approach by using lymphovascular invasion (LVI) and the embryonal component in the primary tumor to select patients most likely to benefit from primary treatment [retroperitoneal lymph node dissection (RPLND) or chemotherapy]. With the surveillance for all strategy, only patients who relapse are treated. While this minimizes the over treatment, problem associated with the risk adapted approach, this exposes young men to the effects of full induction cisplatin-based chemotherapy when these men could have received fewer cycles of bleomycin, etoposide, and cisplatin (BEP) or a curative primary RPLND. The challenge is identifying these men who are most likely to benefit from upfront treatment more precisely. This paper explores the currently risk adapted approaches as well as promising emerging biomarkers (microRNA) that, in early data, appear to more accurately predict the presence of microscopic disease in the retroperitoneum over conventional markers.
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Affiliation(s)
- Ryan P Werntz
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Pathological risk factors for metastatic disease at presentation in testicular seminomas with focus on the recent pT changes in AJCC TNM eighth edition. Hum Pathol 2019; 94:16-22. [DOI: 10.1016/j.humpath.2019.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/05/2019] [Indexed: 11/15/2022]
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Azizi M, Peyton CC, Boulware DC, Gilbert SM, Sexton WJ. Primary tumor size thresholds in stage IA testicular seminoma: Implications for adjuvant therapy after orchiectomy and survival. Urol Oncol 2019; 38:7.e9-7.e18. [PMID: 31704139 DOI: 10.1016/j.urolonc.2019.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Primary tumor size (PTS) is the main prognostic factor for relapse in clinical stage (CS) IA testicular seminoma (T1N0M0S0) and the 8th edition of the Tumor-Node-Metastasis staging system now subcategorizes pT1 tumors into pT1a and pT1b based on PTS (<3 cm and ≥3 cm, respectively). We attempted to assess PTS as a prognosticator for overall survival (OS) in CS IA seminoma and to evaluate the comparative effectiveness of active surveillance (AS) versus adjuvant therapy (AT) in patients with large primary tumors (LPT). METHODS AND MATERIALS In the National Cancer Database (2004-2014), 2455 (47.7%) and 2685 (52.3%) patients with CS IA seminoma were treated with AS and AT, respectively. AT was defined as the receipt of chemotherapy or radiation within 3 months after orchiectomy. A cut-point analysis was performed to determine the optimal PTS threshold predicting OS at 5 years after orchiectomy. Inverse-probability of treatment weighting (IPTW)-adjusted Kaplan-Meier curves and Cox regression analyses were used to compare OS of patients with LPT (using the optimal PTS cut-point) treated with AS versus AT. RESULTS In adjusted analysis, pathologic T-stage (pT1a vs. pT1b) did not predict OS and no OS benefit was noted in pT1b patients treated with AT. The optimal PTS cut-point was 4.5 cm. In multivariable analysis, patients with LPT (≥4.5 cm) had an increased risk of overall mortality (HR = 1.87, P = 0.003). Kaplan-Meier curves revealed that OS was superior in patients with LPT treated with AT (IPTW-adjusted log-rank P = 0.029). In IPTW-adjusted Cox regression analysis, AT was associated with an OS benefit in patients with LPT (HR = 0.59, 95%CI: 0.39-0.91, P = 0.017). CONCLUSIONS In this National Cancer Database analysis, PTS was a predictor of OS in CS IA seminoma. An OS benefit was noted for individuals with LPT (defined as PTS ≥4.5 cm) managed with AT. These findings may warrant refinement of Tumor-Node-Metastasis staging system.
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Affiliation(s)
- Mounsif Azizi
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Charles C Peyton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - David C Boulware
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Wagner T, Toft BG, Engvad B, Lauritsen J, Kreiberg M, Bandak M, Rosenvilde J, Christensen IJ, Pilt AP, Berney D, Daugaard G. Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study. BMJ Open 2019; 9:e033713. [PMID: 31676661 PMCID: PMC6830695 DOI: 10.1136/bmjopen-2019-033713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Approximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease. METHODS AND ANALYSIS All incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model. ETHICS AND DISSEMINATION This study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.
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Affiliation(s)
- Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Grønkær Toft
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birte Engvad
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Jakob Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Kreiberg
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bandak
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Josephine Rosenvilde
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | - Daniel Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Chen Z, Qiu S, Cao D, Guo J, Chen B, Huang Y, Lai L, Bao Y, Dong Q, Liu L, Wei Q. Clinical characteristics of testicular seminoma in individuals in West China: a 10-year follow-up study. Cancer Manag Res 2019; 11:7639-7645. [PMID: 31616180 PMCID: PMC6698585 DOI: 10.2147/cmar.s215537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/22/2019] [Indexed: 02/05/2023] Open
Abstract
Objective To assess the clinical characteristics of testicular seminoma (TS). Patients and methods A testicular cancer (TC) survey was conducted by the Department of Urology, West China Hospital, between 2008 and 2018. Tumors were classified according to the NCCN criteria such as age, tumor size, tumor marker levels, histopathology, clinical stage, initial treatment, follow-up, and clinical outcomes, were obtained from the database of our center. Results Among 155 registered cases of TC with seminomatous element, 127 cases of pure TS were analyzed. All 127 patients with a median age of 37 years were pathologically diagnosed with orchiectomy specimens. Orchiectomy, chemotherapy, and radiotherapy were the main treatments for these patients. Patients with clinical stages I, II, and III testicular cancer of accounted for 81.1% (n=103), 15.7% (n=20), and 3.2% (n=4) of all patients, respectively. After a median follow-up time of 50 months, five patients presented with relapse during follow-up, and one among them died. Of the patients with stage I TS (T1N0M0S0 CS IA), three patients who only underwent orchiectomy relapsed. Among patients with stage II TS (T1N1M0S1 CS IIA), one patient relapsed after orchiectomy, post-surgery chemotherapy and radiotherapy. In four patients with stage III disease (T2N1M1aS1 CS IIIA), one relapsed after orchiectomy and chemotherapy, and died shortly after salvage chemotherapy and radiotherapy due to recurrence. The median overall survival time was 50 months. In all patients, the 2-year overall survival and progression-free survival probabilitis were 98.6% and 98.8%, respectively. Conclusion The present study shows that patients with TS have good prognosis even at an advanced stage. Surveillance after orchiectomy was important for patients with CSI seminoma, and we recommend cisplatin-based chemotherapy as salvage therapy for patients with CSI seminoma. In addition, patients with a maximal tumor diameter >4 cm should undergo post-surgery chemotherapy.
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Affiliation(s)
- Zeyu Chen
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Shi Qiu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Jianbing Guo
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Bo Chen
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yin Huang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China.,West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Li Lai
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Yige Bao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiang Dong
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Liangren Liu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Qiang Wei
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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