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Zeng J, Cary C, Masterson TA. Retroperitoneal Lymph Node Dissection: Perioperative Management and Updates on Surgical Techniques. Urol Clin North Am 2024; 51:407-419. [PMID: 38925743 DOI: 10.1016/j.ucl.2024.03.009] [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
Retroperitoneal lymph node dissection (RPLND) has been an integral part of a multimodal treatment strategy in testicular cancer. Surgeons, over the last decade, have advanced the understanding of RPLND by adopting perioperative care pathways, innovative biomarkers, surgical techniques, and developing algorithms for managing complications. This review summarizes updates on various aspects including the enhanced recovery after surgery pathway, imaging techniques, surgical approaches, dissection templates, and the management of complications. We conclude that RPLND has undergone significant evolution and refinement in the modern era and will continue to hold a critical role in the care of patients with testicular cancer.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, Indiana University, Indianapolis, IN 46202, USA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN 46202, USA
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Mousa A, Anson-Cartwright L, Atenafu EG, Jewett MAS, Bedard P, Jiang DM, Glicksman R, Chung P, Warde P, O'Malley M, Prendeville S, Hamilton RJ. Primary retroperitoneal lymph node dissection for metastatic non-seminomatous germ cell tumours: outcomes and adjuvant chemotherapy. BJU Int 2024. [PMID: 38967557 DOI: 10.1111/bju.16448] [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] [Indexed: 07/06/2024]
Abstract
OBJECTIVES To compare the outcomes and treatment burden of primary retroperitoneal lymph node dissection (pRPLND) alone versus pRPLND + adjuvant chemotherapy (AC) in patients with pathological stage II (PSII) non-seminomatous germ cell tumours (NSGCT). PATIENTS AND METHODS Retrospective review of the Princess Margaret Cancer Center eTestes cancer database identified patients with PSII NSGCT after pRPLND between 1995 and 2020. The primary outcome was relapse-free survival (RFS). Secondary outcomes included disease-specific survival (DSS), burden of relapse treatment, and factors associated with relapse. RESULTS A total of 109 PSII patients were included in the study. There were 96 patients treated with pRPLND alone and 13 treated with pRPLND + AC. The median follow-up was 61 months. The 5-year RFS was 72% for the pRPLND-only group vs 92% for the pRPLND + AC group (hazard ratio [HR] 4.372, 95% confidence interval [CI] 0.59-32.36; P = 0.11). Within the pRPLND-only group the 5-year RFS differed by pN stage (pN1 = 94% vs pN2/N3 = 67%, P = 0.03). Despite a higher relapse rate within the pRPLND-only group, the DSS was similar at 5 years (98% pRPLND only vs 100% pRPLND + AC, P = 0.48). Only 24 (25%) of the patients in the pRPLND-only group required any subsequent chemotherapy. Despite achieving similar survival, the cumulative post-RPLND treatment burden was less for the pRPLND-only group than the pRPLND+AC group overall (average 1.23 vs 2.46 cycles of chemotherapy per patient in group). CONCLUSION The majority of patients with PSII NSGCT treated with pRPLND alone do not experience a recurrence or require chemotherapy. Despite a lower relapse risk when AC is given, no difference in survival was seen but higher chemotherapy burden was entertained. AC may constitute overtreatment for most patients with PSII NSGCT treated with pRPLND.
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Affiliation(s)
- Ahmad Mousa
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lynn Anson-Cartwright
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eshetu G Atenafu
- Biostatistics Core, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Bedard
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Di Maria Jiang
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Chung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Martin O'Malley
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Susan Prendeville
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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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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Yuen KL, Pandit K, Puri D, Yodkhunnatham N, Bagrodia A. Testicular cancer with small metastatic burden: optimal approach in 2024. Curr Opin Urol 2024; 34:204-209. [PMID: 38305430 DOI: 10.1097/mou.0000000000001162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
PURPOSE OF REVIEW Recent advancements in the management of clinical stage II (CS II) testicular cancer have transformed it into a predominantly curable condition. This success in treatment advancements has markedly extended patient survival. However, these treatments carry risks and morbidities, which is important to consider given the disease's impact on young men and the emerging understanding of long-term treatment consequences. RECENT FINDINGS Emerging data support primary retroperitoneal lymph node dissection (RPLND) for select CS II seminoma patients, with similar short-term outcomes to chemotherapy but less treatment intensity. Recent studies have also challenged the reflexive use of adjuvant chemotherapy for pathologic node-positive disease, as growing evidence shows low relapse rates regardless of nodal stage. Furthermore, novel biomarkers like circulating serum microRNA-371a-3p levels can help predict the presence of viable germ cell tumor at time of RPLND. SUMMARY Advances in risk stratification and therapy enable personalized de-escalation approaches for oligometastatic testicular cancer, optimizing survivorship. Upfront RPLND, reassessing adjuvant systemic therapy for RPLND pN+ disease, and novel biomarkers will shape precision treatment to achieve high cure rates with excellent quality of life. Ongoing trials of reduced-intensity regimens, accurate prognostic models, improved surgical strategy, and emerging biomarkers represent the next frontier in tailored curative therapy.
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Affiliation(s)
- Kit L Yuen
- Department of Urology, University of California San Diego, La Jolla, CA, USA
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Heidenreich A, Paffenholz P, Hartmann F, Seelemeyer F, Pfister D. Retroperitoneal Lymph Node Dissection in Clinical Stage IIA/B Metastatic Seminoma: Results of the COlogne Trial of Retroperitoneal Lymphadenectomy In Metastatic Seminoma (COTRIMS). Eur Urol Oncol 2024; 7:122-127. [PMID: 37438222 DOI: 10.1016/j.euo.2023.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/06/2023] [Accepted: 06/23/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Radiation therapy and systemic chemotherapy are recommended treatment options in marker-negative clinical stage (CS) IIA/B seminoma. Despite high cure rates of 82-94%, both therapeutic options are associated with significant long-term toxicities. OBJECTIVE To evaluate the feasibility, oncological efficacy, and treatment-associated morbidity of primary nerve-sparing retroperitoneal lymph node dissection (nsRPLND) in CS IIA/B seminoma. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-arm, clinical phase 2 trial including CS IIA/B seminoma patients was conducted. INTERVENTION Primary nerve-sparing retroperitoneal lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relapse-free and overall survival, surgery-associated complications according to the Clavien-Dindo classification, and Kaplan-Meier methods for survival calculation were assessed. RESULTS AND LIMITATIONS Thirty patients at a mean age of 39.1 (34-52) yr with marker-negative CS IIA and IIB seminomas were recruited. The median follow-up was 22 (8-30) mo. Nineteen (63%) and 11 (36%) patients were diagnosed with stages IIA and B, respectively, at the time of primary diagnosis. Fourteen (47%) and 16 (53%) patients were diagnosed with CS IIA and IIB, respectively, at the time of nsRPLND. Twenty-seven and three patients underwent open and robot-assisted nsRPLND, respectively. The median operating room time was 125 (115-145) min, median blood loss was <150 ml, and median time of hospitalization was 4.5 (3-9) d. Four (13%) patients experienced Clavien-Dindo grade 3a complications. Lymph node histology revealed seminoma in 25 (80%) patients; two and three patients demonstrated embryonal carcinoma and benign disease, respectively. Sixteen patients underwent a serum analysis of miR371 preoperatively, which predicted metastatic disease in 12/13 and benign histology in 3/3 patients. Three of 30 (10%) patients developed an outfield relapse 4, 6, and 9 mo postoperatively and were salvaged by systemic chemotherapy. Limitations are the low patient number and length of follow-up. CONCLUSIONS The nsRPLND approach results in a high cure rate at midterm follow-up and is associated with a low frequency of treatment-associated morbidities, making this approach a feasible alternative to radiation therapy or systemic chemotherapy. PATIENT SUMMARY The standard treatment of clinical stage IIA/B seminomas is radiation therapy or chemotherapy, which results in a significantly increased frequency of long-term toxicity and secondary neoplasms. In this trial, we demonstrate that nerve-sparing retroperitoneal lymph node dissection is a feasible therapeutic approach with low morbidity and high oncological efficacy.
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Affiliation(s)
- 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.
| | - Pia Paffenholz
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Florian Hartmann
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Felix Seelemeyer
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
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Daneshmand S, Hu B, Nichols C. Reply to A. Rumyantsev et al. J Clin Oncol 2023; 41:5203-5204. [PMID: 37677112 DOI: 10.1200/jco.23.01148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Siamak Daneshmand
- Siamak Daneshmand, MD, Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Brian Hu, MD, Department of Urology, Loma Linda University, Loma Linda, CA; and Craig Nichols, MD, Testicular Cancer Commons, Portland, OR
| | - Brian Hu
- Siamak Daneshmand, MD, Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Brian Hu, MD, Department of Urology, Loma Linda University, Loma Linda, CA; and Craig Nichols, MD, Testicular Cancer Commons, Portland, OR
| | - Craig Nichols
- Siamak Daneshmand, MD, Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA; Brian Hu, MD, Department of Urology, Loma Linda University, Loma Linda, CA; and Craig Nichols, MD, Testicular Cancer Commons, Portland, OR
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7
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Krege S. [Will there be a renaissance of surgery in seminomatous lymph node metastases?]. UROLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00120-023-02113-5. [PMID: 37338545 DOI: 10.1007/s00120-023-02113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/21/2023]
Affiliation(s)
- Susanne Krege
- Klinik für Urologie, Kinderurologie und Urologische Onkologie, Ev. Kliniken Essen Mitte, Henricistr. 92, 45136, Essen, Deutschland.
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Daneshmand S, Cary C, Masterson T, Einhorn L, Adra N, Boorjian SA, Kollmannsberger C, Schuckman A, So A, Black P, Bagrodia A, Skinner E, Alemozaffar M, Brand T, Eggener S, Pierorazio P, Stratton K, Nappi L, Nichols C, Luo C, Li M, Hu B. Surgery in Early Metastatic Seminoma: A Phase II Trial of Retroperitoneal Lymph Node Dissection for Testicular Seminoma With Limited Retroperitoneal Lymphadenopathy. J Clin Oncol 2023; 41:3009-3018. [PMID: 36913642 DOI: 10.1200/jco.22.00624] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors with minimal late morbidity although little data exist on its efficacy in early metastatic seminoma. Surgery in early metastatic seminoma is a prospective phase II single-arm, multi-institutional trial of RPLND as first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy. PATIENTS AND METHODS Twelve sites in the United States and Canada prospectively enrolled adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm). Open RPLND was performed by certified surgeons with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. RESULTS A total of 55 patients were enrolled, with a median (IQR) largest clinical lymph node size of 1.6 cm (1.3-1.9). RPLND pathology demonstrated a median (IQR) largest lymph node size of 2.3 cm (0.9-3.5); nine patients (16%) were pN0, 12 (22%) pN1, 31 (56%) pN2, and 3 (5%) pN3. One patient received adjuvant chemotherapy. With a median (IQR) follow-up of 33 months (12.0-61.6), 12 patients experienced recurrence, with a 2-year RFS of 81% and a recurrence rate of 22%. Of the patients who experienced recurrence, 10 were treated with chemotherapy and two underwent additional surgery. At last follow-up, all patients who experienced a recurrence were disease-free and the 2-year overall survival was 100%. Four patients (7%) experienced short-term complications, and four patients experienced long-term complications including incisional hernia (1) and anejaculation (3). CONCLUSION RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.
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Affiliation(s)
- Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN
| | | | - Lawrence Einhorn
- Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Nabil Adra
- Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Anne Schuckman
- Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Alan So
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Peter Black
- Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Eila Skinner
- Department of Urology, Stanford University, Stanford, CA
| | | | - Timothy Brand
- Department of Urology, Madigan Army Medical Center, Tacoma, WA
| | - Scott Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | - Phillip Pierorazio
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Lucia Nappi
- Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada
| | - Craig Nichols
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Chunqiao Luo
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Ming Li
- Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Brian Hu
- Department of Urology, Loma Linda University, Loma Linda, CA
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Neuenschwander A, Lonati C, Antonelli L, Papachristofilou A, Cathomas R, Rothermundt C, Templeton AJ, Gulamhusein A, Fischer S, Gillessen S, Hermanns T, Lorch A, Mattei A, Fankhauser CD. Treatment Outcomes for Men with Clinical Stage II Nonseminomatous Germ Cell Tumours Treated with Primary Retroperitoneal Lymph Node Dissection: A Systematic Review. Eur Urol Focus 2023; 9:541-546. [PMID: 36379869 DOI: 10.1016/j.euf.2022.11.003] [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: 07/16/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
CONTEXT Guidelines recommend primary retroperitoneal lymph node dissection (RPLND) as a treatment option for tumour marker-negative stage II nonseminomatous germ cell tumour (NSGCT). OBJECTIVE To review the literature on oncological outcomes for men with stage II NSGCT treated with RPLND. EVIDENCE ACQUISITION A systematic review of studies describing clinicopathological outcomes following primary RPLND in stage II NSGCT was conducted in the MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. Baseline data, perioperative and postoperative parameters, and oncological outcomes were collected. EVIDENCE SYNTHESIS In total, 12 of 4387 studies were included, from which we collected data for 835 men. Among men with clinical stage II NSGCT, pathological stage II was confirmed in 615 of 790 patients (78%). Most studies administered adjuvant chemotherapy in cases with large lymph nodes, multiple affected lymph nodes, or persistently elevated tumour markers. Recurrence was observed in 12-40% of patients without adjuvant chemotherapy and 0-4% of patients who received adjuvant chemotherapy. CONCLUSIONS The literature describing RPLND in clinical stage II NSGCT is heterogeneous and no meta-analysis was possible, but RPLND can provide accurate staging and may be curative in selected patients. PATIENT SUMMARY We reviewed the literature to summarise results after surgical removal of enlarged lymph nodes in the back of the abdomen in men with testis cancer. This procedure provides accurate information on how far the cancer has spread and may provide a cure in selected patients.
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Affiliation(s)
| | - Chiara Lonati
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Luca Antonelli
- Department of Urology, Policlinico Umberto I, Rome, Italy
| | | | - Richard Cathomas
- Department of Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Arnoud J Templeton
- Department of Oncology, St. Claraspital Basel and St. Clara Research, Basel, Switzerland
| | - Aziz Gulamhusein
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - Stefanie Fischer
- Department of Medical Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Silke Gillessen
- Department of Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Anja Lorch
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zurich, Zurich, Switzerland; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
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10
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Wood GE, Chamberlain F, Tran B, Conduit C, Liow E, Nicol DL, Shamash J, Alifrangis C, Rajan P. Treatment de-escalation for stage II seminoma. Nat Rev Urol 2023:10.1038/s41585-023-00727-0. [PMID: 36882564 DOI: 10.1038/s41585-023-00727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
International Germ Cell Cancer Collaborative Group good-risk metastatic seminoma has cure rates of >95%. Within this risk group, patients with stage II disease exhibit the best oncological outcomes with the standard-of-care treatment strategies of radiotherapy or combination chemotherapy. However, these treatments can be associated with substantial early and late toxic effects. Therapy de-escalation aims to reduce treatment morbidity whilst preserving oncological outcomes. The evidence supporting such approaches is largely from non-randomized institutional data, and therefore this strategy is not recognized as standard of care. Current de-escalation approaches for stage II seminoma include single-agent chemotherapy, radiotherapy and surgery based on early data from clinical studies. Increased recognition of emerging data on treatment modification to reduce morbidity whilst maintaining cure rates and consideration of therapy de-escalation could improve patient survivorship outcomes.
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Affiliation(s)
- Georgina E Wood
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | | | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Elizabeth Liow
- Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - David L Nicol
- Department of Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Jonathan Shamash
- Department of Medical Oncology, Barts Health NHS Trust, London, UK
| | - Constantine Alifrangis
- Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK. .,National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Prabhakar Rajan
- Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK. .,Division of Surgery and Interventional Science, University College London, London, UK. .,Department of Urology, Barts Health NHS Trust, London, UK. .,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
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Reply to Alireza Ghoreifi and Hooman Djaladat's Letter to the Editor re: Isamu Tachibana, Sean Q. Kern, Antoin Douglawi, et al. Primary Retroperitoneal Lymph Node Dissection for Patients with Pathologic Stage II Nonseminomatous Germ Cell Tumor-N1, N2, and N3 Disease: Is Adjuvant Chemotherapy Necessary? J Clin Oncol. In press. https://doi.org/ 10.1200/JCO.22.00118: Is Retroperitoneal Lymph Node Dissection Without Adjuvant Chemotherapy Enough for All Patients with Pathologic Stage II Nonseminoma Germ Cell Tumor? Eur Urol 2023; 83:e20-e21. [PMID: 36195478 DOI: 10.1016/j.eururo.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
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Ghoreifi A, Djaladat H. Re: Isamu Tachibana, Sean Q. Kern, Antoin Douglawi, et al. Primary Retroperitoneal Lymph Node Dissection for Patients with Pathologic Stage II Nonseminomatous Germ Cell Tumor-N1, N2, and N3 Disease: Is Adjuvant Chemotherapy Necessary? J Clin Oncol. In press. https://doi.org/ 10.1200/JCO.22.00118: Is Retroperitoneal Lymph Node Dissection Without Adjuvant Chemotherapy Enough for All Patients with Pathologic Stage II Nonseminoma Germ Cell Tumor? Eur Urol 2023; 83:e18-e19. [PMID: 36195480 DOI: 10.1016/j.eururo.2022.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/24/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Alireza Ghoreifi
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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