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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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3
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Sriram S, Macedo T, Mavinkurve‐Groothuis A, van de Wetering M, Looijenga LHJ. Alkylating agents-induced gonadotoxicity in prepubertal males: Insights on the clinical and preclinical front. Clin Transl Sci 2024; 17:e13866. [PMID: 38965809 PMCID: PMC11224131 DOI: 10.1111/cts.13866] [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: 04/12/2024] [Revised: 05/26/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
Rising cure rates in pediatric cancer patients warrants an increased attention toward the long-term consequences of the diagnosis and treatment in survivors. Chemotherapeutic agents can be gonadotoxic, rendering them at risk for infertility post-survival. While semen cryopreservation is an option that can be provided for most (post)pubertal boys before treatment, this is unfortunately not an option prepubertal in age, simply due to the lack of spermatogenesis. Over the last couple of years, studies have thus focused on better understanding the testis niche in response to various chemotherapeutic agents that are commonly administered and their direct and indirect impact on the germ cell populations. These are generally compounds that have a high risk of infertility and have been classified into risk categories in curated fertility guidelines. However, with it comes the lack of evidence and the challenge of using informative models and conditions most reflective of the physiological scenario, in short, the appropriate study designs for clinically relevant outcomes. Besides, the exact mechanism(s) of action for many of these "risk" compounds as well as other agents is unclear. Understanding their behavior and effect on the testis niche will pave the way for incorporating new strategies to ultimately combat infertility. Of the various drug classes, alkylating agents pose the highest risk of gonadotoxicity as per previously established studies as well as risk stratification guidelines. Therefore, this review will summarize the findings in the field of male fertility concerning gonadotoxicity of akylating agents as a result of chemotherapy exposure.
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Affiliation(s)
- Sruthi Sriram
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Tiago Macedo
- Princess Máxima Center for Pediatric OncologyUtrechtThe Netherlands
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Thor A, Negaard HF, Grenabo Bergdahl A, Almås B, Melsen Larsen S, Lundgren PO, Gerdtsson A, Halvorsen D, Johannsdottir B, Jansson AK, Hellström M, Wahlqvist R, Langberg CW, Hedlund A, Akre O, Glimelius I, Ståhl O, Haugnes HS, Cohn-Cedermark G, Kjellman A, Tandstad T. Primary Retroperitoneal Lymph Node Dissection as Treatment for Low-volume Metastatic Seminoma in a Population-based Cohort: The Swedish Norwegian Testicular Cancer Group Experience. EUR UROL SUPPL 2024; 65:13-19. [PMID: 38966804 PMCID: PMC11222926 DOI: 10.1016/j.euros.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 07/06/2024] Open
Abstract
Background and objective There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy. Methods Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS). Key findings and limitations In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13-24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16-30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4-14). PFS was 90% (95% confidence interval: 0.86-1) and OS was 100% at 24 mo. Conclusions and clinical implications RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity. Patient summary In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.
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Affiliation(s)
- Anna Thor
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Grenabo Bergdahl
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | | | - Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Berglind Johannsdottir
- Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Anna K. Jansson
- Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Martin Hellström
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | | | - Annika Hedlund
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Olof Akre
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics & Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT – The Arctic University of Norway, Tromsø, Norway
| | - Gabriella Cohn-Cedermark
- Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology - Pathology, Karolinska Institute, Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institute, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Fazekas FE, Ujfaludi Z, Biró K, Páhi ZG, Buzogány I, Sükösd F, Pankotai T, Beöthe T. Complex treatment of residual metastatic germ cell cancer: A single center experience. J Biotechnol 2024; 389:61-67. [PMID: 38692356 DOI: 10.1016/j.jbiotec.2024.04.018] [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: 03/27/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Testicular cancer is the most common solid malignancy among men aged 15-35. Radical orchiectomy and platinum-based chemotherapy (BEP) are curative in the majority of patients, including advanced, metastatic cases. According to current urooncology guidelines all non-seminoma patients harbouring post-chemotherapy residual masses of ≥ 1 cm should undergo salvage retroperitoneal lymph node dissection (RPLND). However, only 10% of residual tumors contain viable disease. OBJECTIVE To assess patient outcomes and complications considering different treatment regimens and clinical characteristics. MATERIALS AND METHODS In a retrospective cross-sectional study patients (n=127) who underwent postchemotherapy RPLND between 2007 and 2023 at our referral center were evaluated. The patients received systemic treatment at various oncology centers. The number of BEP cycles received were occasionally different from standard. Only patients with normal postchemotherapy serum tumor markers and primary testicular or extragonadal germ cell neoplasms were included. Treatment groups were established according to the number of BEP cycles received, and the extent of RPLND (bilateral or modified template). Treatment outcomes and complications were assessed. RESULTS Standard 3-4 courses of BEP were received by 100 (78,7%) patients, while 11 (8,7%) patients underwent less, and 16 (12,6%) more courses than standard. On histopathologic evaluation viable germ cell tumor, teratoma, and necrosis/fibrosis was present in 26 (20,5%), 67 (52,7%) and 34 (26,8%) of specimen, respectively. In the 5-6 BEP series subgroup high rate of viable disease (37,5%) was found and significantly more nephrectomies were performed, than other chemotherapy subgroups. Extratesticular GCT, viable disease in residual mass or progression after RPLND indicated lower survival. Mild (Clavien-Dindo I-II) or no postoperative complications were reported in 93,7% of cases. CONCLUSIONS The study suggests no significant benefit from exceeding 3-4 courses of BEP. Timely salvage RPLND should be performed in high volume centers for optimal treatment outcomes with acceptable complication rates. Adherence to the Heidenreich criteria is advisable where practical.
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Affiliation(s)
| | - Zsuzsanna Ujfaludi
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary; Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér, 13, Szeged H-6720, Hungary
| | - Krisztina Biró
- National Institute of Oncology, Dept. of Genitourinary Oncology and Clinical Pharmacology, Budapest, Hungary
| | - Zoltán Gábor Páhi
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary; Hungarian Centre of Excellence for Molecular Medicine (HCEMM), Genome Integrity and DNA Repair Core Group, Budapesti út 9, Szeged H-6728, Hungary; Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér, 13, Szeged H-6720, Hungary
| | - István Buzogány
- Péterfy Sándor Hospital, Dept. of Urology, Budapest, Hungary
| | - Farkas Sükösd
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tibor Pankotai
- Institute of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary; Hungarian Centre of Excellence for Molecular Medicine (HCEMM), Genome Integrity and DNA Repair Core Group, Budapesti út 9, Szeged H-6728, Hungary; Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér, 13, Szeged H-6720, Hungary.
| | - Tamás Beöthe
- Péterfy Sándor Hospital, Dept. of Urology, Budapest, Hungary.
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Cazzaniga W, Pierorazio P, Heidenreich A. Review of Discordance Between American Urological Association and European Association of Urology Guideline Recommendations for Testicular Cancer. Eur Urol Focus 2024:S2405-4569(24)00079-8. [PMID: 38849277 DOI: 10.1016/j.euf.2024.05.016] [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: 04/16/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
We compared the American Urological Association and the European Association of Urology guidelines on testicular cancer. We identified a few differences, in particular for management of low-volume metastatic serum tumor marker-negative stage IIA/B seminoma and nonseminoma, and of advanced and relapsing disease. Overall the rate of concordance between the guidelines is high. PATIENT SUMMARY: We compared guidelines on testicular cancer published by the American Urological Association and the European Association of Urology. We found a high rate of agreement between the two guidelines, with some differences.
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Affiliation(s)
- Walter Cazzaniga
- Department of Urology, Royal Marsden NHS Foundation Trust, London, UK
| | - Phillip Pierorazio
- Section of Urology, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany; Department of Urology, Medical University Vienna, Vienna, Austria.
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7
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Beitzen-Heineke A, Rolling CC, Seidel C, Erley J, Molwitz I, Muellerleile K, Saering D, Senftinger J, Börschel N, Engel NW, Bokemeyer C, Adam G, Tahir E, Chen H. Long-term cardiotoxicity in germ cell cancer survivors after platinum-based chemotherapy: cardiac MR shows impaired systolic function and tissue alterations. Eur Radiol 2024; 34:4102-4112. [PMID: 37982836 PMCID: PMC11166766 DOI: 10.1007/s00330-023-10420-w] [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: 05/11/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Long-term toxicities of germ cell cancer (GCC) treatment are of particular importance in young men with a life expectancy of several decades after curative treatment. This study aimed to investigate the long-term effects of platinum-based chemotherapy on cardiac function and myocardial tissue in GCC survivors by cardiac magnetic resonance (CMR) imaging. METHODS Asymptomatic GCC survivors ≥ 3 years after platinum-based chemotherapy and age-matched healthy controls underwent CMR assessment, including left ventricular (LV) and right ventricular (RV) ejection fraction (EF), strain analysis, late gadolinium enhancement (LGE) imaging, and T1/T2 mapping. RESULTS Forty-four survivors (age 44 [interquartile range, IQR 37-52] years; follow-up time 10 [IQR 5-15] years after chemotherapy) and 21 controls were evaluated. LV- and RVEF were lower in GCC survivors compared to controls (LVEF 56 ± 5% vs. 59 ± 5%, p = 0.017; RVEF 50 ± 7% vs. 55 ± 7%, p = 0.008). Seven percent (3/44) of survivors showed reduced LVEF (< 50%), and 41% (18/44) showed borderline LVEF (50-54%). The strain analysis revealed significantly reduced deformation compared to controls (LV global longitudinal strain [GLS] -13 ± 2% vs. -15 ± 1%, p < 0.001; RV GLS -15 ± 4% vs. -19 ± 4%, p = 0.005). Tissue characterization revealed focal myocardial fibrosis in 9 survivors (20%) and lower myocardial native T1 times in survivors compared to controls (1202 ± 25 ms vs. 1226 ± 37 ms, p = 0.016). Attenuated LVEF was observed after two cycles of platinum-based chemotherapy (54 ± 5% vs. 62 ± 5%, p < 0.001). CONCLUSION Based on CMR evaluation, combination chemotherapy with cumulative cisplatin ≥ 200 mg/m2 is associated with attenuated biventricular systolic function and myocardial tissue alterations in asymptomatic long-term GCC survivors. CLINICAL RELEVANCE STATEMENT Platinum-based chemotherapy is associated with decreased systolic function, non-ischemic focal myocardial scar, and decreased T1 times in asymptomatic long-term germ cell cancer survivors. Clinicians should be particularly aware of the risk of cardiac toxicity after platinum-based chemotherapy. KEY POINTS • Platinum-based chemotherapy is associated with attenuation of biventricular systolic function, lower myocardial T1 relaxation times, and non-ischemic late gadolinium enhancement. • Decreased systolic function and non-ischemic late gadolinium enhancement are associated with a cumulative cisplatin dose of ≥ 200 mg/m2. • Cardiac MRI can help to identify chemotherapy-associated changes in cardiac function and tissue in asymptomatic long-term germ cell cancer survivors.
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Affiliation(s)
- Antonia Beitzen-Heineke
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Christina Charlotte Rolling
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christoph Seidel
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dennis Saering
- Information Technology and Image Processing, University of Applied Sciences Wedel, Wedel, Germany
| | - Juliana Senftinger
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Börschel
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nils Wolfgang Engel
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Hang Chen
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
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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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9
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Gerdtsson A, Negaard HFS, Almås B, Bergdahl AG, Cohn-Cedermark G, Glimelius I, Halvorsen D, Haugnes HS, Hedlund A, Hellström M, Holmberg G, Karlsdóttir Á, Kjellman A, Larsen SM, Thor A, Wahlqvist R, Ståhl O, Tandstad T. Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours. BJU Int 2024; 133:717-724. [PMID: 38293778 DOI: 10.1111/bju.16289] [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] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT. PATIENTS AND METHODS Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. RESULTS Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. CONCLUSIONS Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.
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Affiliation(s)
- Axel Gerdtsson
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Skåne University Hospital, Malmö, Sweden
| | | | - Bjarte Almås
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Anna Grenabo Bergdahl
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Gabriella Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Pelvic Cancer, Genitourinary Oncology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Uppsala, Sweden
| | - Dag Halvorsen
- Department of Urology, St. Olavs University Hospital, Trondheim, Norway
| | - Hege Sagstuen Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT- The Arctic University of Norway, Tromsø, Norway
| | - Annika Hedlund
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Hellström
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Göran Holmberg
- Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenborg, Sweden
| | - Ása Karlsdóttir
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anna Thor
- Department of Clinical Science, Intervention and Technology, Division of Urology, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Rolf Wahlqvist
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Olof Ståhl
- Department of Oncology, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Torgrim Tandstad
- The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, The Norwegian University of Science and Technology, Trondheim, Norway
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Lobo J, Acosta AM, Mego M. Editorial: Molecular mechanisms in testicular germ cell tumors. Front Oncol 2024; 14:1427834. [PMID: 38826779 PMCID: PMC11140773 DOI: 10.3389/fonc.2024.1427834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal
- Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Andres M. Acosta
- Department of Pathology Indiana University, Indianapolis, IN, United States
| | - Michal Mego
- 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava and National Cancer Institute, Bratislava, Slovakia
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11
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Nicu AT, Ionel IP, Stoica I, Burlibasa L, Jinga V. Recent Advancements in Research on DNA Methylation and Testicular Germ Cell Tumors: Unveiling the Intricate Relationship. Biomedicines 2024; 12:1041. [PMID: 38791003 PMCID: PMC11117643 DOI: 10.3390/biomedicines12051041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
Testicular germ cell tumors (TGCTs) are the most common type of testicular cancer, with a particularly high incidence in the 15-45-year age category. Although highly treatable, resistance to therapy sometimes occurs, with devastating consequences for the patients. Additionally, the young age at diagnosis and the treatment itself pose a great threat to patients' fertility. Despite extensive research concerning genetic and environmental risk factors, little is known about TGCT etiology. However, epigenetics has recently come into the spotlight as a major factor in TGCT initiation, progression, and even resistance to treatment. As such, recent studies have been focusing on epigenetic mechanisms, which have revealed their potential in the development of novel, non-invasive biomarkers. As the most studied epigenetic mechanism, DNA methylation was the first revelation in this particular field, and it continues to be a main target of investigations as research into its association with TGCT has contributed to a better understanding of this type of cancer and constantly reveals novel aspects that can be exploited through clinical applications. In addition to biomarker development, DNA methylation holds potential for developing novel treatments based on DNA methyltransferase inhibitors (DNMTis) and may even be of interest for fertility management in cancer survivors. This manuscript is structured as a literature review, which comprehensively explores the pivotal role of DNA methylation in the pathogenesis, progression, and treatment resistance of TGCTs.
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Affiliation(s)
- Alina-Teodora Nicu
- Genetics Department, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania; (A.-T.N.); (I.S.)
| | - Ileana Paula Ionel
- Department of Specific Disciplines, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Ileana Stoica
- Genetics Department, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania; (A.-T.N.); (I.S.)
| | - Liliana Burlibasa
- Genetics Department, Faculty of Biology, University of Bucharest, 030018 Bucharest, Romania; (A.-T.N.); (I.S.)
| | - Viorel Jinga
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
- The Academy of Romanian Scientists, 050044 Bucharest, Romania
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12
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Heinzelbecker J, Kaßmann K, Ernst S, Meyer-Mabileau P, Germanyuk A, Zangana M, Wagenpfeil G, Ohlmann CH, Cohausz M, Stöckle M, Lehmann J. Long-term quality of life of testicular cancer survivors differs according to applied adjuvant treatment and tumour type. J Cancer Surviv 2024:10.1007/s11764-024-01580-9. [PMID: 38658465 DOI: 10.1007/s11764-024-01580-9] [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: 02/01/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To evaluate the quality of life (QoL) in long-term testicular cancer (TC) survivors. METHODS QoL was assessed in TC survivors treated between March 1976 and December 2004 (n = 625) using the EORTC-QLQ-C30 questionnaire, including a TC module. The assessment was performed at two time points (2006: response rate: n = 201/625 (32.2%), median follow-up (FU): 12.9 years (range 1.1-30.9); 2017: response rate: n = 95/201 (47.3%), median FU: 26.2 years (range: 13.0-41.2)). TC survivors were grouped according to treatment strategy, tumour entity, clinical stage and prognosis group. Linear and multiple linear regression analyses were performed, with age and time of follow-up as possible confounders. RESULTS Radiation therapy (RT) compared to retroperitoneal lymph node dissection (RPLND) was associated with a higher impairment of physical function (2017: β = - 9.038; t(84) = - 2.03; p = 0.045), role function (2017: β = - 12.764; t(84) = - 2.00; p = 0.048), emotional function (2006: β = - 9.501; t(183) = - 2.09; p = 0.038) and nausea (2006: β = 6.679; t(185) = 2.70; p = 0.008). However, RT was associated with a lower impairment of sexual enjoyment (2017: symptoms: β = 26.831; t(64) = 2.66; p = 0.010; functional: β = 22.983; t(65) = 2.36; p = 0.021). Chemotherapy (CT), compared to RPLND was associated with a higher impairment of role (2017: β = - 16.944; t(84) = - 2.62; p = 0.011) and social function (2017: β = - 19.160; t(79) = - 2.56; p = 0.012), more insomnia (2017: β = 19.595; t(84) = 2.25; p = 0.027) and greater concerns about infertility (2017: β = 19.830; t(80) = 2.30; p = 0.024). In terms of tumour type, nonseminomatous germ cell tumour (NSGCT) compared to seminoma survivors had significantly lower impairment of nausea (2006: β = - 4.659; t(187) = - 2.17; p = 0.031), appetite loss (2006: β = - 7.554; t(188) = - 2.77; p = 0.006) and future perspective (2006: β = - 12.146; t(175) = - 2.08; p = 0.039). On the other hand, surviving NSGCT was associated with higher impairment in terms of sexual problems (2006: β = 16.759; t(145) = 3.51; p < 0.001; 2017: β = 21.207; t(63) = 2.73; p = 0.008) and sexual enjoyment (2017: β = - 24.224; t(66) = - 2.76; p = 0.008). CONCLUSIONS The applied adjuvant treatment and the tumour entity had a significant impact on the long-term QoL of TC survivors, even more than 25 years after the completion of therapy. Both RT and CT had a negative impact compared to survivors treated with RPLND, except for sexual concerns. NSGCT survivors had a lower impairment of QoL compared to seminoma survivors, except in terms of sexual concerns. IMPLICATIONS FOR CANCER SURVIVORS Implications for cancer survivors are to raise awareness of aspects of long-term and late effects on QoL in TC survivors; offer supportive care, such as psycho-oncological support or lifestyle modification, if a deterioration in QoL is noticed; and avoid toxic treatment without compromising a cure whenever possible.
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Affiliation(s)
- Julia Heinzelbecker
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany.
| | - Karla Kaßmann
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Department of Neurology, Heilig Geist-Krankenhaus, Graseggerstr. 105, 50737, Cologne-Longerich, Germany
| | - Simone Ernst
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Centre of Palliative Care and Pediatric Pain, Saarland University Medical Centre and Saarland University, Kirrbergerstr. 100, 66421, Homburg/Saar, Germany
| | - Pia Meyer-Mabileau
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
| | - Aleksandra Germanyuk
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
| | - Miran Zangana
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Campus Homburg/Saar, 66421, Homburg/Saar, Germany
| | - Carsten H Ohlmann
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Department of Urology, Johanniter Krankenhaus, Johanniterstr. 3-5, 53113, Bonn, Germany
| | - Maximilian Cohausz
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Urologische Gemeinschaftspraxis Münster, Fürstenbergstr. 5, 48147, Münster, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
| | - Jan Lehmann
- Department of Urology and Pediatric Urology, Saarland University Medical Centre and Saarland University, Kirrberger Str. 100, 66421, Homburg/Saar, Germany
- Urologische Gemeinschaftspraxis Pruener Gang, Pruener Grang 15, 24103, Kiel, Germany
- Städtisches Krankenhaus Kiel, Chemnitzstr. 33, 24116, Kiel, Germany
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Ameri P, Bertero E, Lombardi M, Porto I, Canepa M, Nohria A, Vergallo R, Lyon AR, López-Fernández T. Ischaemic heart disease in patients with cancer. Eur Heart J 2024; 45:1209-1223. [PMID: 38323638 DOI: 10.1093/eurheartj/ehae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Cardiologists are encountering a growing number of cancer patients with ischaemic heart disease (IHD). Several factors account for the interrelationship between these two conditions, in addition to improving survival rates in the cancer population. Established cardiovascular (CV) risk factors, such as hypercholesterolaemia and obesity, predispose to both IHD and cancer, through specific mechanisms and via low-grade, systemic inflammation. This latter is also fuelled by clonal haematopoiesis of indeterminate potential. Furthermore, experimental work indicates that IHD and cancer can promote one another, and the CV or metabolic toxicity of anticancer therapies can lead to IHD. The connections between IHD and cancer are reinforced by social determinants of health, non-medical factors that modify health outcomes and comprise individual and societal domains, including economic stability, educational and healthcare access and quality, neighbourhood and built environment, and social and community context. Management of IHD in cancer patients is often challenging, due to atypical presentation, increased bleeding and ischaemic risk, and worse outcomes as compared to patients without cancer. The decision to proceed with coronary revascularization and the choice of antithrombotic therapy can be difficult, particularly in patients with chronic coronary syndromes, necessitating multidisciplinary discussion that considers both general guidelines and specific features on a case by case basis. Randomized controlled trial evidence in cancer patients is very limited and there is urgent need for more data to inform clinical practice. Therefore, coexistence of IHD and cancer raises important scientific and practical questions that call for collaborative efforts from the cardio-oncology, cardiology, and oncology communities.
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Affiliation(s)
- Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Edoardo Bertero
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Comprehensive Heart Failure Center (CHFC), University Clinic Würzburg, Würzburg, Germany
| | - Marco Lombardi
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, Roma, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rocco Vergallo
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Viale Benedetto XV, 6, 16132 Genova, Italy
| | | | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
- Cardiology Department, Quirón Pozuelo University Hospital, Madrid, Spain
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van der Meer DJ, Karim-Kos HE, Elzevier HW, Dinkelman-Smit M, Kerst JM, Atema V, Lehmann V, Husson O, van der Graaf WTA. The increasing burden of testicular seminomas and non-seminomas in adolescents and young adults (AYAs): incidence, treatment, disease-specific survival and mortality trends in the Netherlands between 1989 and 2019. ESMO Open 2024; 9:102231. [PMID: 38244349 PMCID: PMC10937200 DOI: 10.1016/j.esmoop.2023.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Testicular cancer incidence among adolescents and young adults (AYAs, aged 18-39 years at diagnosis) is increasing worldwide and most patients will survive the initial disease. Still, detailed epidemiological information about testicular cancer among AYAs is scarce. This study aimed to provide a detailed overview of testicular cancer trends in incidence, treatment, long-term relative survival and mortality by histological subtype among AYAs diagnosed in the Netherlands between 1989 and 2019. MATERIALS AND METHODS Data of all malignant testicular cancers (ICD-code C62) were extracted from the Netherlands Cancer Registry. Mortality data were retrieved from Statistics Netherlands. European age-standardized incidence and mortality rates with average annual percentage change statistics and relative survival estimates up to 20 years of follow-up were calculated. RESULTS A total of 12 528 testicular cancers were diagnosed between 1989 and 2019. Comparing 1989-1999 to 2010-2019, the incidence increased from 4.4 to 11.4 for seminomas and from 5.7 to 11.1 per 100 000 person-years for non-seminomas. Rising trends were most prominent for localized disease. Radiotherapy use in localized testicular seminomas declined from 78% in 1989-1993 to 5% in 2015-2019. Meanwhile, there was a slight increase in chemotherapy use. Most AYAs with localized seminomas and non-seminomas received active surveillance only (>80%). Overall, relative survival estimates remained well above 90% even at 20 years of follow-up for both seminomas and non-seminomas. Mortality rates declined from 0.5 to 0.4 per 100 000 person-years between 1989-1999 and 2010-2019. CONCLUSIONS The incidence of seminoma and non-seminoma testicular cancers significantly increased in AYAs in the Netherlands between 1989 and 2019. There was a shift towards less-aggressive treatment regimens without negative survival effects. Relative survival estimates remained well above 90% at 20 years of follow-up in most cases. Testicular cancer mortality was already low, but has improved further over time, which makes survivorship care an important issue for these young adults.
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Affiliation(s)
- D J van der Meer
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam.
| | - H E Karim-Kos
- Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht
| | - H W Elzevier
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden
| | - M Dinkelman-Smit
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam
| | - J M Kerst
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam
| | - V Atema
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht
| | - V Lehmann
- Department of Medical Psychology, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam; Cancer Center Amsterdam (CCA), Amsterdam
| | - O Husson
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam; Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - W T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam
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15
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Krege S, Oing C, Bokemeyer C. Testicular Tumors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:843-854. [PMID: 37378600 PMCID: PMC10824497 DOI: 10.3238/arztebl.m2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Germ-cell tumors of the testes are the most common type of malignant tumor in men aged 20 to 40. Their incidence in Germany is 10 per 100 000 men per year, with an estimated 4200 new cases annually. METHODS This selective review is based on the recommendations of the German clinical practice guideline on the diagnosis, treatment and follow-up care of testicular germ-cell tumors, as well as on pertinent original articles and reviews. RESULTS The treatment of germ-cell tumors requires an interdisciplinary approach comprising resection of the affected testis followed by further steps that depend on the histological type and stage of the tumor, which may include active surveillance, chemotherapy, radiotherapy, further surgery, or some combination of these measures. Two-thirds of germ-cell tumors are diagnosed in clinical stage I, when they are still confined to the testis; one-third are already metastatic when diagnosed, with organ metastases in 10-15%. Stage-based multimodal treatment approaches are associated with cure rates of more than 99% for stage I tumors and 67-95% for advanced metastatic disease, depending on the degree of progression. CONCLUSION For patients with early-stage tumors, overtreatment should be avoided in order to minimize long-term sequelae. For those whose tumors are in advanced stages, it must be decided which patients should receive intensified treatment to optimize the outcome. Multimodal treatment approaches are associated with high cure rates even for patients with metastatic disease.
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Affiliation(s)
- Susanne Krege
- Department of Urology, Pediatric Urology, and Urological Oncology, Essen-Mitte Hospital, Essen
- * Joint first authors
| | - Christoph Oing
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
- Department of Oncology, Hematology, and Stem Cell Transplantation, Pulmonology Section, University Hospital Hamburg Eppendorf, Hamburg
- * Joint first authors
| | - Carsten Bokemeyer
- Department of Oncology, Hematology, and Stem Cell Transplantation, Pulmonology Section, University Hospital Hamburg Eppendorf, Hamburg
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16
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Conduit C, Hutchinson AD, Leonard M, O 'Haire S, Moody M, Thomas B, Sim I, Hong W, Ahmad G, Lawrentschuk N, Lewin J, Tran B, Dhillon HM. An exploration of testicular cancer survivors' experience of ejaculatory dysfunction following retroperitoneal lymph node dissection-a sub-study of the PREPARE clinical trial. J Cancer Surviv 2023:10.1007/s11764-023-01489-9. [PMID: 37981616 DOI: 10.1007/s11764-023-01489-9] [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: 08/29/2023] [Accepted: 10/20/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Ejaculatory dysfunction secondary to retrograde ejaculation or anejaculation is a complication of retroperitoneal lymph node dissection (RPLND) for survivors of testicular cancer. We explored survivors' experiences of ejaculatory dysfunction following RPLND. METHODS In a sub-study of a single-arm phase 2 clinical trial (ACTRN12622000537752/12622000542796), participants reporting ejaculatory dysfunction ≥ 6 months following RPLND were invited to complete semi-structured interviews. Purposive sampling was used. Interviews continued until thematic saturation occurred, and codebook thematic analysis of interviews was performed. RESULTS Of 58 individuals recruited to the trial, 33 (57%) reported ejaculatory dysfunction. Of these, 32 (97%) agreed to interview and 15 participated. Participants interviewed had median age 34 years (range 24-66), 12 (80%) in a long-term relationship with median time from surgery 36 months (range 11-112). Three overarching themes were identified. The first reflected the value of RPLND despite ejaculatory dysfunction. The second illuminated the impact(s) of ejaculatory dysfunction closely mapped to life stage, with flow-on impacts to fertility, sex, psychological wellbeing and communication. The third reflected information needs. Fertility was a substantial source of concern for some participants. Ejaculatory dysfunction had no effect on sex for some, whilst for others, sex was less pleasurable. Some reported benefits. Few reported ejaculatory dysfunction challenged masculinity, confidence, or self-esteem. CONCLUSIONS Future research should examine interventions to reduce distress related to fertility, challenged masculinity and body image. IMPLICATIONS FOR CANCER SURVIVORS Whilst most participants considered ejaculatory dysfunction to have little impact on their sexual function and relationships, some reported significant difficulties varying by life stage and relationship status.
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Affiliation(s)
- C Conduit
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - A D Hutchinson
- Justice & Society, Behaviour-Brain-Body Research Centre, University of South Australia, Magill, Australia
| | - M Leonard
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, Australia
| | - S O 'Haire
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - M Moody
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - B Thomas
- Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - I Sim
- Endocrinology, Monash Health and Eastern Health, Clayton, VIC, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - W Hong
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - G Ahmad
- Andrology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - N Lawrentschuk
- Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
- Urology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Lewin
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Melbourne, VIC, Australia
| | - B Tran
- Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, 305 Grattan St., Melbourne, VIC, Australia.
- Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
| | - H M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
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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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18
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Thorsen L, Courneya KS, Steene-Johannessen J, Gran JM, Haugnes HS, Negaard HFS, Kiserud CE, Fosså SD. Association of physical activity with overall mortality among long-term testicular cancer survivors: A longitudinal study. Int J Cancer 2023; 153:1512-1519. [PMID: 37334652 DOI: 10.1002/ijc.34625] [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: 02/08/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023]
Abstract
Physical activity (PA) has been associated with reduced mortality among cancer survivors, but no study has focused on testicular cancer survivors (TCSs). We aimed to investigate the association of PA measured twice during survivorship with overall mortality in TCSs. TCSs treated during 1980 to 1994 participated in a nationwide longitudinal survey between 1998 to 2002 (S1: n = 1392) and 2007 to 2009 (S2: n = 1011). PA was self-reported by asking for the average hours per week of leisure-time PA in the past year. Responses were converted into metabolic equivalent task hours/week (MET-h/wk) and participants were categorized into: Inactives (0 MET-h/wk), Low-Actives (2-6 MET-h/wk), Actives (10-18 MET-h/wk) and High-Actives (20-48 MET-h/wk). Mortality from S1 and S2, respectively, was analyzed using the Kaplan-Meier estimator and Cox proportional hazards models until the End of Study (December 31, 2020). Mean age at S1 was 45 years (SD 10.2). Nineteen percent (n = 268) of TCSs died between S1 and EoS, with 138 dying after S2. Compared to Inactives at S1, the mortality risk among Actives was 51% lower (HR 0.49, 95% CI: 0.29-0.84) with no further mortality reduction among High-Actives. At S2, the mortality risk was at least 60% lower among the Actives, High-Actives and even the Low-Actives compared to the Inactives. Persistent Actives (≥10 MET-h/wk at S1 and S2) had a 51% lower mortality risk compared to Persistent Inactives (<10 MET-h/wk at S1 and S2; HR 0.49, 95% CI: 0.30-0.82). During long-term survivorship after TC treatment, regular and maintained PA were associated with an overall mortality risk reduction of at least 50%.
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Affiliation(s)
- Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | | | - Jon Michael Gran
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, University of Tromsø - The Arctic University, Tromsø, Norway
| | | | - Cecilie E Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Sophie D Fosså
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Lobo J, Acosta AM, Netto GJ. Molecular Biomarkers With Potential Clinical Application in Testicular Cancer. Mod Pathol 2023; 36:100307. [PMID: 37611872 DOI: 10.1016/j.modpat.2023.100307] [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: 06/20/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
Testicular germ cell tumors (TGCTs) and sex cord-stromal tumors (SCSTs) are the most common testicular neoplasms. The morphologic spectrum of such tumors is wide, with several histologic subtypes within each group. Testicular tumors often represent a diagnostic challenge, requiring proper identification of their biologic potential for accurate risk stratification and selection of therapy. In the era of precision medicine, molecular biomarkers are increasingly assuming a critical role in the management of patients with cancer. Given the overall rarity of certain types of testicular neoplasms, progress in biomarker research has been relatively slow. However, in recent years, we have witnessed a multitude of important contributions, including both tissue-based and liquid biopsy biomarkers, stemming from important discoveries of tumor pathobiology, accurate histopathological analysis, multi-institutional studies, and genome-wide molecular analyses of specific tumor subtypes. In this review, we provide an overview of the progress in molecular biomarkers of TGCTs and SCSTs, focusing on those with greatest potential for clinical application. In TGCTs, developmental biology has been the key to understanding these tumors and identifying clinically useful biomarkers (from classical serum tumor markers to pluripotency factors and circulating microRNAs of the 371-373 cluster). For SCSTs, studies have focused on tissue biomarkers only, and genome-wide investigations have recently contributed to a better understanding of rare phenotypes and the aggressive biological behavior of some tumors within this nosologic category. Several new biomarkers are moving toward clinical implementation in this field. Therefore, the practicing pathologist should be aware of their strengths and limitations in order to utilize them properly and maximize their clinical benefits.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC), Porto, Portugal; Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca & RISE@CI-IPOP (Health Research Network), Porto, Portugal; Department of Pathology and Molecular Immunology, ICBAS-School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Andres M Acosta
- Department of Pathology, Indiana University, Indianapolis, Indiana
| | - George J Netto
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
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20
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Rønde HS, Kronborg C, Høyer M, Hansen J, Bak ME, Agergaard SN, Als AB, Agerbæk M, Lauritsen J, Meidahl Petersen P, Dysager L, Kallehauge JF. Dose comparison of robustly optimized intensity modulated proton therapy (IMPT) vs IMRT and VMAT photon plans for testicular seminoma. Acta Oncol 2023; 62:1222-1229. [PMID: 37683054 DOI: 10.1080/0284186x.2023.2254925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Patients with stage II seminoma have traditionally been treated with photons to the retroperitoneal and iliac space, which leads to a substantial dose bath to abdominal and pelvic organs at risk (OAR). As these patients are young and with excellent prognosis, reducing dose to OAR and thereby the risk of secondary cancer is of utmost importance. We compared IMPT to opposing IMRT fields and VMAT, assessing dose to OAR and both overall and organ-specific secondary cancer risk. MATERIAL AND METHODS A comparative treatment planning study was conducted on planning CT-scans from ten patients with stage II seminoma, treated with photons to a 'dog-leg' field with doses ranging from 20 to 25 Gy and a 10 Gy sequential boost to the metastatic lymph node(s). Photon plans were either 3-4 field IMRT (Eclipse) or 1-2 arc VMAT (Pinnacle). Proton plans used robust (5 mm; 3.5%) IMPT (Eclipse), multi field optimization with 3 posterior fields supplemented by 2 anterior fields at the level of the iliac vessels. Thirty plans were generated. Mean doses to OARs were compared for IMRT vs IMPT and VMAT vs IMPT. The risk of secondary cancer was calculated according to the model described by Schneider, using excess absolute risk (EAR, per 10,000 persons per year) for body outline, stomach, duodenum, pancreas, bowel, bladder and spinal cord. RESULTS Mean doses to all OARs were significantly lower with IMPT except similar kidney (IMRT) and spinal cord (VMAT) doses. The relative EAR for body outline was 0.59 for IMPT/IMRT (p < .05) and 0.33 for IMPT/VMAT (p < .05). Organ specific secondary cancer risk was also lower for IMPT except for pancreas and duodenum. CONCLUSION Proton therapy reduced radiation dose to OAR compared to both IMRT and VMAT plans, and potentially reduce the risk of secondary cancer both overall and for most OAR.
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Affiliation(s)
- Heidi S Rønde
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Kronborg
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jolanta Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jesper F Kallehauge
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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21
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Wang Z, Li B, Xing J, Gong Z, Xu A, Wang Z. Causes of death after testicular cancer diagnosis: a US population-based analysis. BMC Urol 2023; 23:144. [PMID: 37660082 PMCID: PMC10475185 DOI: 10.1186/s12894-023-01309-3] [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: 07/09/2022] [Accepted: 08/10/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND After the introduction of cisplatin-based chemotherapy, the survival time of testicular cancer (TC) patients has improved dramatically. However, the overall risk of death in patients with TC remains significantly higher than in the general population. The aim of this study was to assess and quantify the causes of death after TC diagnosis. METHOD In total, 44,975 men with TC in the United States diagnosed and registered by the Surveillance, Epidemiology, and End Results (SEER) database during 2000 to 2018 were studied. In this study, standardized mortality rates (SMRs) were calculated for each cause of death in TC individuals and further analyzed in strata according to age and race. RESULT Of the included participants, 3,573 (7.94%) died during the follow-up period. The greatest proportion of deaths (38.20%) occurred within 1 to 5 years after diagnosis. Most deaths occurred from TC itself and other cancers. For non-malignant conditions, the most common causes of death within 1 years after diagnosis were accidents and adverse effects (53, 4.75%) followed by diseases of heart (45, 4.04%). However, > 1 years after diagnosis, the most common noncancer causes of death were heart diseases. Results of stratified analysis show that non-Hispanic White TC participants have a lower SMR (0.68, 95% CI, 33.39-38.67) from Cerebrovascular Diseases than the general U.S. POPULATION CONCLUSIONS Although TC remains the most common cause of death after TC diagnosis, other non-TC causes of death represent a significant number of deaths among TC men. These findings help TC survivors understand the various health risks that may occur at different follow-up periods.
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Affiliation(s)
- Zhongyuan Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Baochao Li
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Jiajun Xing
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Zixuan Gong
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China
| | - Aiming Xu
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China.
| | - Zengjun Wang
- Department of Urology, First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Street, Nanjing, 210029, Jiangsu Province, China.
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22
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Tichanek F, Försti A, Hemminki A, Hemminki O, Hemminki K. Long-Term Periodic and Conditional Survival Trends in Prostate, Testicular, and Penile Cancers in the Nordic Countries, Marking Timing of Improvements. Cancers (Basel) 2023; 15:4261. [PMID: 37686536 PMCID: PMC10486399 DOI: 10.3390/cancers15174261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Survival studies are important tools for cancer control, but long-term survival data on high-quality cancer registries are lacking for all cancers, including prostate (PC), testicular (TC), and penile cancers. Using generalized additive models and data from the NORDCAN database, we analyzed 1- and 5-year relative survival for these cancers in Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) over a 50-year period (1971-2020). We additionally estimated conditional 5/1-year survival for patients who survived the 1st year after diagnosis. Survival improved early for TC, and 5-year survival reached 90% between 1985 (SE) and 2000 (FI). Towards the end of the follow-up, the TC patients who had survived the 1st year survived the next 4 years with comparable probability to the background population. For PC, the 90% landmark was reached between 2000 (FI) and after 2010 (DK). For penile cancer, 5-year survival never reached the 90% landmark, and the improvements in survival were modest at best. For TC, early mortality requires attention, whereas late mortality should be tackled for PC. For penile cancer, the relatively high early mortality may suggest delays in diagnosis and would require more public awareness and encouragement of patients to seek medical opinion. In FI, TC and penile cancer patients showed roughly double risk of dying compared to the other Nordic countries, which warrants further study and clinical attention.
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Affiliation(s)
- Filip Tichanek
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic;
| | - Asta Försti
- Hopp Children’s Cancer Center (KiTZ), 69120 Heidelberg, Germany;
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), 69120 Heidelberg, Germany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, 00014 Helsinki, Finland; (A.H.); (O.H.)
- Comprehensive Cancer Center, Helsinki University Hospital, 00290 Helsinki, Finland
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, 00014 Helsinki, Finland; (A.H.); (O.H.)
- Department of Urology, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University Pilsen, 30605 Pilsen, Czech Republic;
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, 69120 Heidelberg, Germany
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23
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Lubberts S, Groot HJ, de Wit R, Mulder S, Witjes JA, Kerst JM, Groenewegen G, Lefrandt JD, van Leeuwen FE, Nuver J, Schaapveld M, Gietema JA. Cardiovascular Disease in Testicular Cancer Survivors: Identification of Risk Factors and Impact on Quality of Life. J Clin Oncol 2023; 41:3512-3522. [PMID: 37071834 PMCID: PMC10306438 DOI: 10.1200/jco.22.01016] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 01/02/2023] [Accepted: 02/21/2023] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Testicular cancer (TC) treatment is clearly associated with cardiovascular morbidity and mortality. To enable development of preventive strategies for cardiovascular disease (CVD), we assessed cardiometabolic risk factors and quality of life (QoL) in TC survivors. METHODS Incidence of coronary artery disease, myocardial infarction, and heart failure after TC treatment was assessed in a multicenter cohort comprising 4,748 patients treated at the age of 12-50 years between 1976 and 2007. Patients who had developed CVD and a random sample from the cohort (subcohort) received a questionnaire on cardiometabolic risk factors and QoL. A subgroup of responders in the subcohort additionally underwent clinical evaluation of cardiovascular risk factors. RESULTS After a median follow-up of 16 years, 272 patients had developed CVD. Compared with orchidectomy only, cisplatin combination chemotherapy was associated with an increased CVD risk (hazard ratio [HR], 1.9; 95% CI, 1.1 to 3.1). Patients who were obese or a smoker at diagnosis (HR, 4.6; 95% CI, 2.0 to 10.0 and HR, 1.7; 95% CI, 1.1 to 2.4, respectively), developed Raynaud's phenomenon (HR, 1.9; 95% CI, 1.1 to 3.6) or dyslipidemia (HR, 2.8; 95% CI, 1.6 to 4.7) or had a positive family history for CVD (HR, 2.9; 95% CI, 1.7 to 4.9) had higher CVD risk. More TC survivors with CVD reported inferior QoL on physical domains than survivors who did not develop CVD. Of 304 TC survivors who underwent clinical evaluation for cardiovascular risk factors (median age at assessment: 51 years), 86% had dyslipidemia, 50% had hypertension, and 35% had metabolic syndrome, irrespective of treatment. CONCLUSION Cardiovascular events in TC survivors impair QoL. Many TC survivors have undetected cardiovascular risk factors. We advocate early lifestyle adjustments and lifelong follow-up with low-threshold treatment of cardiovascular risk factors, especially in obese and smoking patients treated with platinum-based chemotherapy.
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Affiliation(s)
- Sjoukje Lubberts
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Harmke J. Groot
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sasja Mulder
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Johannes A. Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J. Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joop D. Lefrandt
- Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Burlibasa L, Nicu AT, Chifiriuc MC, Medar C, Petrescu A, Jinga V, Stoica I. H3 histone methylation landscape in male urogenital cancers: from molecular mechanisms to epigenetic biomarkers and therapeutic targets. Front Cell Dev Biol 2023; 11:1181764. [PMID: 37228649 PMCID: PMC10203431 DOI: 10.3389/fcell.2023.1181764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
During the last decades, male urogenital cancers (including prostate, renal, bladder and testicular cancers) have become one of the most frequently encountered malignancies affecting all ages. While their great variety has promoted the development of various diagnosis, treatment and monitoring strategies, some aspects such as the common involvement of epigenetic mechanisms are still not elucidated. Epigenetic processes have come into the spotlight in the past years as important players in the initiation and progression of tumors, leading to a plethora of studies highlighting their potential as biomarkers for diagnosis, staging, prognosis, and even as therapeutic targets. Thus, fostering research on the various epigenetic mechanisms and their roles in cancer remains a priority for the scientific community. This review focuses on one of the main epigenetic mechanisms, namely, the methylation of the histone H3 at various sites and its involvement in male urogenital cancers. This histone modification presents a great interest due to its modulatory effect on gene expression, leading either to activation (e.g., H3K4me3, H3K36me3) or repression (e.g., H3K27me3, H3K9me3). In the last few years, growing evidence has demonstrated the aberrant expression of enzymes that methylate/demethylate histone H3 in cancer and inflammatory diseases, that might contribute to the initiation and progression of such disorders. We highlight how these particular epigenetic modifications are emerging as potential diagnostic and prognostic biomarkers or targets for the treatment of urogenital cancers.
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Affiliation(s)
| | | | - Mariana Carmen Chifiriuc
- Faculty of Biology, University of Bucharest, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
- Romanian Academy, Bucharest, Romania
| | - Cosmin Medar
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Clinical Hospital “Prof. dr Theodor Burghele”, Bucharest, Romania
| | - Amelia Petrescu
- Clinical Hospital “Prof. dr Theodor Burghele”, Bucharest, Romania
| | - Viorel Jinga
- Academy of Romanian Scientists, Bucharest, Romania
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Clinical Hospital “Prof. dr Theodor Burghele”, Bucharest, Romania
| | - Ileana Stoica
- Faculty of Biology, University of Bucharest, Bucharest, Romania
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Nguyen DD, Wallis CJD, Fleshner NE, Trinh QD, Klaassen Z, Sayyid RK. Urologic Oncology Survivorship Guidelines: An Overview of the Evidence and the Current Implementation Gap. Eur Urol Focus 2023; 9:431-434. [PMID: 36842920 DOI: 10.1016/j.euf.2023.02.006] [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] [Received: 12/14/2022] [Revised: 01/29/2023] [Accepted: 02/15/2023] [Indexed: 02/27/2023]
Abstract
Cancer survivorship is particularly significant for patients with urologic malignancies, who account for >25% of cancer survivors. The American Cancer Society has a guideline on survivorship care in prostate cancer and the American Urological Association has published a core curriculum on cancer survivorship in urologic cancers. However, there is a lack of high-quality evidence on survivorship strategies to inform guideline recommendations. Future efforts need to focus on producing high-quality survivorship research and on increasing appropriate resources to improve the implementation of survivorship care. PATIENT SUMMARY: There are few guidelines on survivorship care for patients with prostate, bladder, penile, or kidney cancer. More funding is needed for research into care for cancer survivors.
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Affiliation(s)
- David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Neil E Fleshner
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Quoc-Dien Trinh
- Division of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Zachary Klaassen
- Section of Urology, Department of Surgery, Augusta University, Augusta, GA, USA
| | - Rashid K Sayyid
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada.
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26
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Clasen SC, Fung C, Sesso HD, Travis LB. Cardiovascular Risks in Testicular Cancer: Assessment, Prevention, and Treatment. Curr Oncol Rep 2023; 25:445-454. [PMID: 36867377 DOI: 10.1007/s11912-023-01375-8] [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] [Accepted: 12/23/2022] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW Testicular cancer (TC) is the leading cancer in men between 18 and 39 years of age. Current treatment involves tumor resection followed by surveillance and/or one or more lines of cisplatin-based chemotherapy (CBCT) and/or bone marrow transplant (BMT). Ten years after treatment, CBCT has been associated with significant atherosclerotic cardiovascular disease (CVD) including myocardial infarction (MI), stroke, and heightened rates of hypertension, dyslipidemia, diabetes mellitus, and metabolic syndrome (MetS). Additionally, low testosterone levels and hypogonadism contribute to MetS and may further drive CVD. RECENT FINDINGS CVD in TCS has been associated with worse physical functioning accompanied by role limitations, decreased energy, and decreased overall health. Exercise may play a role in ameliorating these effects. Systematic CVD screening practices are needed at TC diagnosis and in survivorship. We encourage a multidisciplinary partnership between primary care physicians, cardiologists, cardio-oncologists, medical oncologists, and survivorship providers to address these needs.
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Affiliation(s)
- Suparna C Clasen
- Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indiana University, 1800 N. Capitol Ave., E308, Indianapolis, IN, 46202, USA.
| | - Chunkit Fung
- Division of Hematology and Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Howard D Sesso
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lois B Travis
- Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indianapolis, IN, USA
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Salazar-Valdivia FE, Valdez-Cornejo VA, Ulloque-Badaracco JR, Hernandez-Bustamante EA, Alarcón-Braga EA, Mosquera-Rojas MD, Garrido-Matta DP, Herrera-Añazco P, Benites-Zapata VA, Hernandez AV. Systemic Immune-Inflammation Index and Mortality in Testicular Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13050843. [PMID: 36899987 PMCID: PMC10000460 DOI: 10.3390/diagnostics13050843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
The systemic immune-inflammation index (SIII) is a marker studied in multiple types of urologic cancer. This systematic review evaluates the association between SIII values with overall survival (OS) and progression-free survival (PFS) in testicular cancer. We searched observational studies in five databases. The quantitative synthesis was performed using a random-effects model. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The only measure of the effect was the hazard ratio (HR). A sensitivity analysis was performed according to the risk of bias in the studies. There were 833 participants in a total of 6 cohorts. We found that high SIII values were associated with worse OS (HR = 3.28; 95% CI 1.3-8.9; p < 0.001; I2 = 78) and PFS (HR = 3.9; 95% CI 2.53-6.02; p < 0.001; I2 = 0). No indication of small study effects was found in the association between SIII values and OS (p = 0.5301). High SIII values were associated with worse OS and PFS. However, further primary studies are suggested to enhance the effect of this marker in different outcomes of testicular cancer patients.
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Affiliation(s)
- Farley E. Salazar-Valdivia
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Valeria A. Valdez-Cornejo
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | | | - Enrique A. Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo 13011, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima 15012, Peru
| | - Esteban A. Alarcón-Braga
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Melany D. Mosquera-Rojas
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Sociedad Científica de Estudiantes de Medicina de la Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | | | - Percy Herrera-Añazco
- Escuela de Medicina, Universidad Privada San Juan Bautista, Lima 15067, Peru
- Universidad Privada del Norte, Trujillo 13011, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 14072, Peru
- Correspondence: ; Tel.: +51-1-3171000
| | - Adrian V. Hernandez
- Unidad de Revisiones Sistemáticas y Meta-análisis, Guías de Práctica Clínica y Evaluaciones de Tecnología Sanitaria, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima 15012, Peru
- Health Outcomes, Policy, and Evidence Synthesis Group, University of Connecticut School of Pharmacy, Mansfield, CT 06269, USA
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Ozgun G, Nappi L. Primary Mediastinal Germ Cell Tumors: A Thorough Literature Review. Biomedicines 2023; 11:biomedicines11020487. [PMID: 36831022 PMCID: PMC9953372 DOI: 10.3390/biomedicines11020487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Primary mediastinal germ cell tumors (PMGCTs) are a rare type of cancer affecting young adults. They have different molecular and clinical features compared to testicular germ cell tumors. Non-seminoma PMGCTs have the shortest 5-year overall survival and the poorest prognosis among all of the germ cell tumor presentations, while seminomas share the same survival and prognosis as their testicular counterparts. There is an unmet need for better treatment options for patients with non-seminoma PMGCTs in both first-line and salvage therapy, as the available options are associated with underwhelming outcomes. Identifying biological and genetic factors to predict treatment responses would be helpful in improving the survival of these patients.
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Tavares NT, Henrique R, Jerónimo C, Lobo J. Targeting histone deacetylases in testicular germ cell tumours: an encouraging treatment approach for the future †. J Pathol 2023; 259:115-118. [PMID: 36426822 DOI: 10.1002/path.6037] [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: 11/08/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Epidrugs, specifically histone deacetylase inhibitors (HDACi), have been increasingly used in preclinical studies for the treatment of testicular germ cell tumours (TGCTs). SINHCAF was recently described as a potential oncogene in TGCTs located on chromosome 12p, the hallmark of type II (malignant) TGCTs. The findings contribute to the field by further supporting the efficacy of HDACi in the treatment of TGCTs, promoting the design of more preclinical studies and providing the motivation for future implementation of clinical studies with these compounds. © 2022 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Nuno Tiago Tavares
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal
| | - Rui Henrique
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal.,Department of Pathology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
| | - João Lobo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal.,Department of Pathology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
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Shamash J, Ng K. Balancing efficacy with long-term side-effects: can we safely de-escalate therapy for germ cell tumors? Expert Rev Anticancer Ther 2023; 23:127-134. [PMID: 36648077 DOI: 10.1080/14737140.2023.2162042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The success in the management of germ cell tumors has encouraged researchers to pay more attention on long-term side effects and other survivorship issues. The de-escalation of treatment is intended to reduce side effects but must be balanced against any compromise of efficacy. Cisplatin-based therapy is the cornerstone of treatment for germ cell tumors. However, they can result in acute and long-term side effects, including ototoxicity, neurotoxicity, nephrotoxicity, and increased risk of second malignancies. AREAS COVERED This review discusses approaches of de-escalation including biomarker-directed treatment using microRNAs, surveillance for immature teratoma, the use of carboplatin monotherapy for seminoma, and the option of non-cisplatin-based approaches in relapsed germ cell tumors. EXPERT OPINION While the results with the current standard options in terms of cancer control are very good, the price being paid in terms of long-term side effects is considerable.
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Affiliation(s)
| | - Kenrick Ng
- Medical Oncology, Barts Health NHS Trust, London, UK
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31
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Albersen M, Van den Broeck T. Stage II Seminoma: Is There Something New on the Horizon? EUR UROL SUPPL 2023; 49:78-79. [PMID: 36793749 PMCID: PMC9923177 DOI: 10.1016/j.euros.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/31/2023] Open
Affiliation(s)
| | - Thomas Van den Broeck
- Corresponding author. Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
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32
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Yin Y, Zhou Y, Zhou J, Zhao L, Hu H, Xiao M, Niu B, Peng J, Dai Y, Tang Y. Cisplatin causes erectile dysfunction by decreasing endothelial and smooth muscle content and inducing cavernosal nerve senescence in rats. Front Endocrinol (Lausanne) 2023; 14:1096723. [PMID: 36761198 PMCID: PMC9905444 DOI: 10.3389/fendo.2023.1096723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Cisplatin (cis-diamminedichloroplatinum II, CDDP), a drug widely used for cancer worldwide, may affect erectile function, but its side effects have not received enough attention. To investigate the effect of CDDP on erectile function and its possible mechanism. METHODS Sprague-Dawley rats were intraperitoneally administered CDDP (CDDP group) or the same volume of normal saline (control group). Erectile function was evaluated after a one-week washout. Then, histologic changes in the corpus cavernosum and cavernous nerve (CN) were measured. Other Sprague-Dawley rats were used to isolate the major pelvic ganglion and cavernous nerve (MPG/CN). RSC96 cells were then treated with CDDP. SA-β-gal staining was used to identify senescent cells, and qPCR was used to detect the senescence-associated secretory phenotype (SASP). Finally, the supernatant of RSC96 cells was used to culture MPG/CN. Erectile function was measured after administration of CDDP. The cavernosum levels of α-SMA, CD31, eNOS, and γ-H2AX, the apoptosis rate and the expression of p16, p21 and p53 in CN were also assayed. The senescent phenotype of RSC96 cells treated with CDDP was identified, and neurite growth from the MPG/CN was photographed and measured. RESULTS The CDDP group had a significantly lower ICP/MAP ratio than the control group. Compared to the control group, the CDDP group exhibited significantly lower α-SMA, CD31 and eNOS levels and significantly higher γ-H2AX and apoptosis rates in corpus cavernosum. In addition, CDDP increased some senescence markers p16, p21 and p53 in CN. In vitro, CDDP induced RSC96 senescence and SASP, and the supernatant of senescent cells slowed neurite outgrowth of MPG/CN. DISCUSSIONS CDDP treatment could induce erectile dysfunction, by affecting the content of endothelial and smooth muscle and causing SASP in CN. The results indicate that CDDP treatment should be considered as a risk factor for ED. Clinicians should pay more attention to the erectile function of cancer patients who receive CDDP treatment.
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Affiliation(s)
- Yinghao Yin
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Yihong Zhou
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Jun Zhou
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Liangyu Zhao
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Hongji Hu
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Ming Xiao
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Bin Niu
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Jingxuan Peng
- Department of Urology, First Affiliated Hospital of Jishou University, Jishou, Hunan, China
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
| | - Yuxin Tang
- Department of Urology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
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Christiansen AJ, Lobo J, Fankhauser CD, Rothermundt C, Cathomas R, Batavia AA, Grogg JB, Templeton AJ, Hirschi-Blickenstorfer A, Lorch A, Gillessen S, Moch H, Beyer J, Hermanns T. Impact of differing methodologies for serum miRNA-371a-3p assessment in stage I testicular germ cell cancer recurrence. Front Oncol 2022; 12:1056823. [PMID: 36568207 PMCID: PMC9773982 DOI: 10.3389/fonc.2022.1056823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Current evidence shows that serum miR-371a-3p can identify disease recurrence in testicular germ cell tumour (TGCT) patients and correlates with tumour load. Despite convincing evidence showing the advantages of including miR-371a-3p testing to complement and overcome the classical serum tumour markers limitations, the successful introduction of a serum miRNA based test into clinical practice has been impeded by a lack of consensus regarding optimal methodologies and lack of a universal protocol and thresholds. Herein, we investigate two quantitative real-time PCR (qRT-PCR) based pipelines in detecting disease recurrence in stage I TGCT patients under active surveillance, and compare the sensitivity and specificity for each method. Methods Sequential serum samples collected from 33 stage I TGCT patients undergoing active surveillance were analysed for miR-371a-3p via qRT-PCR with and without an amplification step included. Results Using a pre-amplified protocol, all known recurrences were detected via elevated miR-371a-3p expression, while without pre-amplification, we failed to detect recurrence in 3/10 known recurrence patients. For pre-amplified analysis, sensitivity and specificity was 90% and 94.4% respectively. Without amplification, sensitivity dropped to 60%, but exhibited 100% specificity. Discussion We conclude that incorporating pre-amplification increases sensitivity of miR-371a-3p detection, but produces more false positive results. The ideal protocol for quantification of miR-371a-3p still needs to be determined. TGCT patients undergoing active surveillance may benefit from serum miR-371a-3p quantification with earlier detection of recurrences compared to current standard methods. However, larger cross-institutional studies where samples are processed and data is analysed in a standardised manner are required prior to its routine clinical implementation.
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Affiliation(s)
- Ailsa J. Christiansen
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland,Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - João Lobo
- Cancer Biology and Epigenetics Group, Research Center of Portuguese Institute of Oncology (IPO) Porto, RISE@CI-IPOP Health Research Network, Portuguese Oncology Institute of Porto, Porto Comprehensive Cancer Center, Porto, Portugal,Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal,Department of Pathology and Molecular Immunology, ICBAS–School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Christian D. Fankhauser
- University of Zurich, Zurich, Switzerland,Clinic for Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Richard Cathomas
- Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Aashil A. Batavia
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Josias B. Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Arnoud J. Templeton
- St. Clara Research, St. Claraspital Basel and Faculty of Medicine, University of Basel, Basel, Switzerland
| | | | - Anja Lorch
- Department of Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silke Gillessen
- Department of Oncology, Kantonsspital, St. Gallen, Switzerland,Department of Medical Oncology, Ente Ospedaliero Cantonale (EOC) Oncology Institute of Southern Switzerland, Bellinzona, Switzerland,Faculty of Biomedical Sciences Universita della Svizzera Italiana, Lugano, Switzerland,Department of Medical Oncology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jörg Beyer
- Department of Medical Oncology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland,*Correspondence: Thomas Hermanns,
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Trama A, Bernasconi A, Botta L, Byrne J, Grabow D, Reulen RC, Calaminus G, Terenziani M. Late mortality reduction among survivors of germ cell tumors in childhood and adolescence in Europe: A report from the PanCareSurFup cohort. Pediatr Blood Cancer 2022; 69:e29991. [PMID: 36184796 DOI: 10.1002/pbc.29991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data on late mortality from pediatric germ cell tumors (GCTs) are limited to small case series. Our population-based study aimed to investigate excess risk of death in survivors of GCT in childhood and adolescence, whether long-term mortality changed over time and by period of diagnosis. METHODS The PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 2773 five-year survivors diagnosed under 21 years of age with gonadal and extragonadal GCT (from 1940 to 2008). We calculated standardized mortality ratios (SMRs) and absolute excess risks (AERs). We fitted a Cox's model to assess the impact of treatment period. We estimated 10-year survival and calculated average percentage changes between periods of diagnosis (1970-1979, 1980-1989, 1990-1999) to assess whether late mortality decreased. RESULTS GCT survivors had an almost four-fold excess risk of dying compared to general population. The risk of death for patients treated after 1980 was nearly halved compared to patients treated before 1980. Survivors diagnosed in 1990-1999 had a 10-year survival rate of 99%, which was 2.4% and 1.1% higher than for patients treated in 1970-1979 and 1980-1989, respectively. CONCLUSIONS This is the largest population-based study in Europe and showed a decrease in long-term mortality for survivors of GCTs in childhood and adolescence over the last decades. After the introduction of platinum compound in 1980, which is a paradigm of success compared to the previous treatments, no major changes in drug therapies have been made to treat GCTs in the last 40 years. However, GCT survivors maintain an excessive risk of death that requires long-term care.
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Affiliation(s)
- Annalisa Trama
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alice Bernasconi
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Botta
- Evaluative Epidemiology Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Desiree Grabow
- German Childhood Cancer Registry, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Monica Terenziani
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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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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36
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Lobo J, Leão R. Editorial: Diagnostic and predictive biomarkers in testicular germ cell tumors. Front Oncol 2022; 12:1027363. [PMID: 36176416 PMCID: PMC9513745 DOI: 10.3389/fonc.2022.1027363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- João Lobo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal
- Department of Pathology, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Centre (Porto.CCC), Porto, Portugal
- Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
- *Correspondence: João Lobo, ; ; Ricardo Leão, ;
| | - Ricardo Leão
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- *Correspondence: João Lobo, ; ; Ricardo Leão, ;
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Ranasinghe R, Mathai ML, Zulli A. Cisplatin for cancer therapy and overcoming chemoresistance. Heliyon 2022; 8:e10608. [PMID: 36158077 PMCID: PMC9489975 DOI: 10.1016/j.heliyon.2022.e10608] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Cisplatin spearheads the anticancer chemotherapeutics in present-day use although acute toxicity is its primary impediment factor. Among a plethora of experimental medications, a drug as effective or surpassing the benefits of cisplatin has not been discovered yet. Although Oxaliplatin is considered more superior to cisplatin, the former has been better for colorectal cancer while cisplatin is widely used for treating gynaecological cancers. Carcinoma imposes a heavy toll on mortality rates worldwide despite the novel treatment strategies and detection methods that have been introduced; nanomedicine combined with precision medicine, immunotherapy, volume-regulated anion channels, and fluorodeoxyglucose-positron emission tomography. Millions of deaths occur annually from metastatic cancers which escape early detection and the concomitant diseases caused by highly toxic chemotherapy that causes organ damage. It continues due to insufficient knowledge of the debilitative mechanisms induced by cancer biology. To overcome chemoresistance and to attenuate the adverse effects of cisplatin therapy, both in vitro and in vivo models of cisplatin-treated cancers and a few multi-centred, multi-phasic, randomized clinical trials in pursuant with recent novel strategies have been tested. They include plant-based phytochemical compounds, de novo drug delivery systems, biochemical/immune pathways, 2D and 3D cell culture models using small molecule inhibitors and genetic/epigenetic mechanisms, that have contributed to further the understanding of cisplatin's role in modulating the tumour microenvironment. Cisplatin was beneficial in cancer therapy for modulating the putative cellular mechanisms; apoptosis, autophagy, cell cycle arrest and gene therapy of micro RNAs. Specific importance of drug influx, efflux, systemic circulatory toxicity, half-maximal inhibition, and the augmentation of host immunometabolism have been identified. This review offers a discourse on the recent anti-neoplastic treatment strategies to enhance cisplatin efficacy and to overcome chemoresistance, given its superiority among other tolerable chemotherapies.
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Affiliation(s)
- Ranmali Ranasinghe
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
| | - Michael L Mathai
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
| | - Anthony Zulli
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
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Constâncio V, Tavares NT, Henrique R, Jerónimo C, Lobo J. MiRNA biomarkers in cancers of the male reproductive system: are we approaching clinical application? Andrology 2022; 11:651-667. [PMID: 35930290 DOI: 10.1111/andr.13258] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Specific cancer types face specific clinical management challenges. Owing to their stability, robustness and fast, easy, and cost-effective detection, microRNAs (miRNAs) are attractive candidate biomarkers to the clinic. OBJECTIVES Based on a comprehensive review of the relevant literature in the field, we explore the potential of miRNAs as biomarkers to answer relevant clinical dilemmas inherent to cancers of the male reproductive tract (prostate (PCa), testis (TGCTs) and penis (PeCa)) and identify some of the challenges/limitations hampering their widely application. RESULTS AND DISCUSSION We conclude that the use of miRNAs as biomarkers is at different stages for these distinct cancer types. While for TGCTs, miRNA-371a-3p is universally accepted to fill in important clinicals gaps and is moving fast towards clinical implementation, for PCa almost no overlap of miRNAs exists between studies, denoting the absence of a consistent miRNA biomarker, and for PeCa the field of miRNAs has just recently started, with only a few studies attempting to explore their clinical usefulness. CONCLUSION Technological advances influencing miRNA detection and quantification will be instrumental to continue to move forward with implementation of miRNAs in the clinic as biomarkers for non-invasive diagnosis, risk stratification, treatment monitoring and follow-up. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vera Constâncio
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Doctoral Programme in Biomedical Sciences, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
| | - Nuno Tiago Tavares
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal
| | - Rui Henrique
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology, Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
| | - João Lobo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP) / RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology, Portuguese Oncology Institute of Porto / Porto Comprehensive Cancer Centre (Porto.CCC), R. Dr. António Bernardino de Almeida, Porto, 4200-072, Portugal.,Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, Porto, 4050-513, Portugal
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Shrem NS, Wood L, Hamilton RJ, Kuhathaas K, Czaykowski P, Roberts M, Matthew A, Izard JP, Chung P, Nappi L, Jones J, Soulières D, Aprikian A, Power N, Canil C. Testicular cancer survivorship: Long-term toxicity and management. Can Urol Assoc J 2022; 16:257-272. [PMID: 35905486 PMCID: PMC9343164 DOI: 10.5489/cuaj.8009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Noa Shani Shrem
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Robert J. Hamilton
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kopika Kuhathaas
- Division of Urology, Department of Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, CancerCare Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jason P. Izard
- Departments of Urology and Oncology, Queen’s University, Kingston, ON, Canada
| | - Peter Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Hospital, University of Health Network, University of Toronto, Toronto, ON, Canada
| | - Lucia Nappi
- Division of Medical Oncology, British Columbia Cancer - Vancouver Cancer Centre, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Denis Soulières
- Division of Medical Oncology/Hematology, Le Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Armen Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Nicholas Power
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Christina Canil
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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DNA Methylation Biomarkers for Prediction of Response to Platinum-Based Chemotherapy: Where Do We Stand? Cancers (Basel) 2022; 14:cancers14122918. [PMID: 35740584 PMCID: PMC9221086 DOI: 10.3390/cancers14122918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Platinum-based agents are one of the most widely used chemotherapy drugs for various types of cancer. However, one of the main challenges in the application of platinum drugs is resistance, which is currently being widely investigated. Epigenetic DNA methylation-based biomarkers are promising to aid in the selection of patients, helping to foresee their platinum therapy response in advance. These biomarkers enable minimally invasive patient sample collection, short analysis, and good sensitivity. Hence, improved methodologies for the detection and quantification of DNA methylation biomarkers will facilitate their use in the choice of an optimal treatment strategy. Abstract Platinum-based chemotherapy is routinely used for the treatment of several cancers. Despite all the advances made in cancer research regarding this therapy and its mechanisms of action, tumor resistance remains a major concern, limiting its effectiveness. DNA methylation-based biomarkers may assist in the selection of patients that may benefit (or not) from this type of treatment and provide new targets to circumvent platinum chemoresistance, namely, through demethylating agents. We performed a systematic search of studies on biomarkers that might be predictive of platinum-based chemotherapy resistance, including in vitro and in vivo pre-clinical models and clinical studies using patient samples. DNA methylation biomarkers predictive of response to platinum remain mostly unexplored but seem promising in assisting clinicians in the generation of more personalized follow-up and treatment strategies. Improved methodologies for their detection and quantification, including non-invasively in liquid biopsies, are additional attractive features that can bring these biomarkers into clinical practice, fostering precision medicine.
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Albers P. The SEMITEP Trial: Less May Be More. Eur Urol 2022; 82:180-181. [PMID: 35606232 DOI: 10.1016/j.eururo.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Albers
- Department of Urology, Düsseldorf University Hospital, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany.
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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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Wibmer AG, Dinh PC, Travis LB, Chen C, Bromberg M, Zheng J, Capanu M, Sesso HD, Feldman DR, Vargas HA. Associations of Body Fat Distribution and Cardiometabolic Risk of Testicular Cancer Survivors after Cisplatin-Based Chemotherapy. JNCI Cancer Spectr 2022; 6:6585341. [PMID: 35801305 PMCID: PMC9263534 DOI: 10.1093/jncics/pkac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/18/2022] [Accepted: 01/26/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
It is unknown how body fat distribution modulates the cardiometabolic risk of testicular cancer survivors (TCSs) after cisplatin-based chemotherapy.
Methods
For 455 patients enrolled in The Platinum Study at Memorial Sloan Kettering Cancer Center, visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified on pre-chemotherapy CT. VAT/SAT ratio was calculated as a quantitative measure of central adiposity. Endpoints were incidence of new post-chemotherapy cardiometabolic disease (new antihypertensive, lipid-lowering, or diabetes medication), and post-chemotherapy Framingham risk scores. Cox models and linear regression with interaction terms were applied. Post-chemotherapy body fat distribution was analyzed in 108 patients. All statistical tests were 2-sided.
Results
Baseline median age was 31 years (IQR = 26, 39), BMI 26 kg/m2 (IQR: 24, 29), and VAT/SAT ratio 0.49 (IQR: 0.31, 0.75). Median follow-up was 26 months (IQR: 16, 59). Higher pre-chemotherapy VAT/SAT ratios inferred a higher likelihood of new cardiometabolic disease among patients with BMI ≥30 kg/m2 (age-adjusted HR = 3.14, 95% CI = 1.02–9.71, p = 0.047), but not other BMI groups. Pre-chemotherapy VAT/SAT ratio was associated with post-chemotherapy Framingham risk scores in univariate regression analysis (exp(β)-estimate: 2.10, 95% CI: 1.84, 2.39, p < 0.001); in a multivariate model, this association was stronger in younger versus older individuals. BMI increased in most patients after chemotherapy and correlated with increases in VAT/SAT (Spearman r = 0.39; p < 0.001).
Conclusions
In TCSs, central adiposity is associated with increased cardiometabolic risk after cisplatin-based chemotherapy, particularly in obese or young men. Weight gain after chemotherapy occurs preferentially in the visceral compartment, providing insight into the pathogenesis of cardiovascular disease in this population.
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Affiliation(s)
- Andreas G Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul C Dinh
- Indiana University School of Medicine, Department of Medicine, Indianapolis, IN, USA
| | - Lois B Travis
- Indiana University School of Medicine, Department of Medicine, Indianapolis, IN, USA
- Department of Epidemiology, Fairbanks School of Public Health, Indiana University, USA
| | - Carol Chen
- Department of Medicine, Cardiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Bromberg
- Department of Medicine, Genitourinary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Howard D Sesso
- Brigham and Women's Hospital, Department of Medicine, Boston, MA, USA
| | - Darren R Feldman
- Department of Medicine, Genitourinary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Trapani D, Franzoi MA, Burstein HJ, Carey LA, Delaloge S, Harbeck N, Hayes DF, Kalinsky K, Pusztai L, Regan MM, Sestak I, Spanic T, Sparano J, Jezdic S, Cherny N, Curigliano G, Andre F. Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification. Ann Oncol 2022; 33:702-712. [PMID: 35550723 DOI: 10.1016/j.annonc.2022.03.273] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The landscape of clinical trials testing risk-adapted modulations of cancer treatments is complex. Multiple trial designs, endpoints, and thresholds for non-inferiority have been used; however, no consensus or convention has ever been agreed to categorise biomarkers useful to inform the treatment intensity modulation of cancer treatments. METHODS An expert subgroup under the European Society for Medical Oncology (ESMO) Precision Medicine Working Group shaped an international collaborative project to develop a classification system for biomarkers used in the cancer treatment de-intensification, based on a tiered approach. A group of disease-oriented clinical, translational, methodology and public health experts, and patients' representatives provided an analysis of the status quo, and scanned the horizon of ongoing clinical trials. The classification was developed through multiple rounds of expert revisions and inputs. RESULTS The working group agreed on a univocal definition of treatment de-intensification. Evidence of reduction in the dose-density, intensity, or cumulative dose, including intermittent schedules or shorter treatment duration or deletion of segment(s) of the standard regimens, compound(s), or treatment modality must be demonstrated, to define a treatment de-intensification. De-intensified regimens must also portend a positive impact on toxicity, quality of life, health system burden, or financial toxicity. ESMO classification categorises the biomarkers for treatment modulation in three tiers, based on the level of evidence. Tier A includes biomarkers validated in prospective, randomised, non-inferiority clinical trials. The working group agreed that in non-inferiority clinical trials, boundaries are highly dependent upon the disease scenario and endpoint being studied and that the absolute differences in the outcomes are the most relevant measures, rather than relative differences. Biomarkers tested in single-arm studies with a threshold of non-inferiority are classified as Tier B. Tier C is when the validation occurs in prospective-retrospective quality cohort investigations. CONCLUSIONS ESMO classification for the risk-guided intensity modulation of cancer treatments provides a set of evidence-based criteria to categorise biomarkers deemed to inform de-intensification of cancer treatments, in risk-defined patients. The classification aims at harmonising definitions on this matter, therefore offering a common language for all the relevant stakeholders, including clinicians, patients, decision-makers, and for clinical trials.
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Affiliation(s)
- D Trapani
- New Drugs Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Medical Oncology, Dana-Farber Cancer Center, Boston, USA
| | - M A Franzoi
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Center, Boston, USA
| | - L A Carey
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Delaloge
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| | - D F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - K Kalinsky
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, USA
| | - L Pusztai
- Yale Cancer Center Genetics and Genomics Program, Yale Cancer Center, Yale School of Medicine, New Haven, USA
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - I Sestak
- Wolfson Institute of Preventive Medicine - Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Spanic
- ESMO Patient Advocates Working Group, Ljubljana, Slovenia
| | - J Sparano
- Division of Hematology/Oncology, Icahn School of Medicine at Mt. Sinai, Tisch Cancer Institute, New York, USA
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - N Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, European Institute of Oncology, IRCCS, Milan, Italy.
| | - F Andre
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France.
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Nicu AT, Medar C, Chifiriuc MC, Gradisteanu Pircalabioru G, Burlibasa L. Epigenetics and Testicular Cancer: Bridging the Gap Between Fundamental Biology and Patient Care. Front Cell Dev Biol 2022; 10:861995. [PMID: 35465311 PMCID: PMC9023878 DOI: 10.3389/fcell.2022.861995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Testicular cancer is the most common solid tumor affecting young males. Most testicular cancers are testicular germ cell tumors (TGCTs), which are divided into seminomas (SGCTs) and non-seminomatous testicular germ cell tumors (NSGCTs). During their development, primordial germ cells (PGCs) undergo epigenetic modifications and any disturbances in their pattern might lead to cancer development. The present study provides a comprehensive review of the epigenetic mechanisms–DNA methylation, histone post-translational modifications, bivalent marks, non-coding RNA–associated with TGCT susceptibility, initiation, progression and response to chemotherapy. Another important purpose of this review is to highlight the recent investigations regarding the identification and development of epigenetic biomarkers as powerful tools for the diagnostic, prognostic and especially for epigenetic-based therapy.
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Affiliation(s)
- Alina-Teodora Nicu
- Faculty of Biology, University of Bucharest, Bucharest, Romania
- Department of Genetics, University of Bucharest, Bucharest, Romania
| | - Cosmin Medar
- University of Medicine and Pharmacy “Carol Davila”, Clinical Hospital “Prof. dr Theodor Burghele”, Bucharest, Romania
| | - Mariana Carmen Chifiriuc
- Faculty of Biology, University of Bucharest, Bucharest, Romania
- Research Institute of University of Bucharest (ICUB), Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
- Romanian Academy, Bucharest, Romania
| | | | - Liliana Burlibasa
- Faculty of Biology, University of Bucharest, Bucharest, Romania
- Department of Genetics, University of Bucharest, Bucharest, Romania
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Barnett TL. From Cancer Patient to Provider: An Autobiographical Case Report. Cureus 2021; 13:e20764. [PMID: 35111449 PMCID: PMC8794429 DOI: 10.7759/cureus.20764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/15/2022] Open
Abstract
Testicular cancer is considered to be the model for the curable neoplasm, with outcomes improving from nearly universal fatality to nearly universal cure in the matter of two decades, driven largely in part by the accidental discovery and application of platinum chemotherapy. Such a diagnosis and treatment can have significant and long-lasting effects on patients, although with every such experience come learning opportunities. This autobiographical case report describes the author’s experience being diagnosed with testicular cancer, the challenges faced during treatment and survivorship, the lessons learned being a patient, and the way they guided him on his path to his current role as an adolescent and young adult (AYA) oncologist.
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Fung C, Travis LB. Testicular Cancer Survivorship: Looking Back to Move Forward. J Clin Oncol 2021; 39:3531-3534. [PMID: 34591594 PMCID: PMC8577670 DOI: 10.1200/jco.21.01984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Chunkit Fung
- Division of Hematology and Oncology, Department of Medicine, University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Institute, Rochester, NY
| | - Lois B. Travis
- Department of Medicine, Indiana University School of Medicine, Department of Epidemiology Fairbanks School of Public Health, Indianapolis, IN
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Alsyouf M, Daneshmand S. Clinical stage II seminoma: management options. World J Urol 2021; 40:343-348. [PMID: 34655305 DOI: 10.1007/s00345-021-03854-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The management of clinical stage II seminoma has evolved with a recent emphasis on minimizing long-term morbidity while achieving oncologic cure. METHODS In this review we discuss the available management options for clinical stage II seminoma with an emphasis on the emerging role of surgery in this patient population. RESULTS Historically, treatment options available to clinical stage II seminoma patients were limited to radiotherapy and chemotherapy. Survival rates with these options are excellent; however, both are associated with significant long-term morbidities including cardiovascular, pulmonary, and neurologic toxicities. Additionally, higher rates of secondary malignancies are witnessed in this young patient population, decades after successful treatment of the primary cancer. Recently, retroperitoneal lymph node dissection has been proposed as a first-line treatment option for patients with low-volume metastatic seminoma. CONCLUSION The SEMS and PRIMETEST trials are two studies examining the role of primary retroperitoneal lymph node dissection in clinical stage II seminoma, and early data show significant promise.
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Affiliation(s)
- Muhannad Alsyouf
- USC Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., suite 7416, Los Angeles, CA, 90089, USA
| | - Siamak Daneshmand
- USC Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., suite 7416, Los Angeles, CA, 90089, USA.
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