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Joyce DD, Sharma V, Wymer KM, Moriarty JP, Borah BJ, Walia A, Costello BA, Pagliaro LC, Daneshmand S, Leibovich BC, Boorjian SA. Comparative cost-effectiveness of contemporary treatment strategies for stage IIA seminoma. J Natl Cancer Inst 2024; 116:468-475. [PMID: 37819776 DOI: 10.1093/jnci/djad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The Surgery in Early Metastatic Seminoma (SEMS) trial examined retroperitoneal lymph node dissection as first-line treatment for patients with isolated 1-3 cm retroperitoneal lymphadenopathy. To date, the standard of care for these patients has been either chemotherapy or radiotherapy. Herein, we evaluated the relative cost-effectiveness of these management strategies. METHODS A microsimulation model assessed the cost-effectiveness of retroperitoneal lymph node dissection, chemotherapy, and radiotherapy for stage IIA seminoma. Sensitivity analyses were performed to evaluate model robustness. Retroperitoneal lymph node dissection recurrence probabilities were obtained from the SEMS trial. All other probability and utility values were obtained from published literature. Primary outcomes included costs from a commercial insurer's perspective, effectiveness (quality adjusted life-years [QALYs]), and incremental cost-effectiveness ratios using a willingness-to-pay threshold of $100 000/QALY. RESULTS At a lifetime horizon, the mean costs per patient for retroperitoneal lymph node dissection, radiotherapy, and chemotherapy were $58 469, $98 783, and $104 096, and the mean QALYs were 40.61, 40.70, and 39.15, respectively. Retroperitoneal lymph node dissection was found to be the most cost-effective approach because of high costs and accrued disutility of chronic toxicities associated with radiotherapy (cost-effectiveness ratios = $433 845/QALY) and chemotherapy (dominated). On 1-way sensitivity analyses, retroperitoneal lymph node dissection was no longer cost-effective if the probabilities of infertility and cardiovascular toxicity after radiotherapy were less than 13% and 16%, respectively, or if the 2-year probability of progression after retroperitoneal lymph node dissection was more than 26%. CONCLUSIONS Retroperitoneal lymph node dissection was the most cost-effective treatment approach for stage IIA seminoma. These findings support clinical guideline consideration of including retroperitoneal lymph node dissection as a treatment option for well-selected patients with stage IIA seminoma.
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Affiliation(s)
- Daniel D Joyce
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vidit Sharma
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin M Wymer
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Department of Health Services Research, Mayo Clinic, Rochester, MN, USA
| | - Arman Walia
- Department of Urology, University of California, San Diego, CA, USA
| | | | | | - Siamak Daneshmand
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Bradley C Leibovich
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A Boorjian
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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Rosen DB, Ghosh A, Niemierko A, Beard CJ, Ravi P, Tewari A, Sweeney C, Lee RJ, Saylor P, Martin N, Efstathiou JA, Mouw K, Kamran SC. Clinical Outcomes of De Novo Versus Relapsed Early Metastatic Testicular Seminoma Treated With Contemporary Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:706-711. [PMID: 37717783 DOI: 10.1016/j.ijrobp.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE Chemotherapy (CHT) or radiation therapy (RT) are first-line treatments for clinical stage II (CS-II) testicular seminoma. Historically, clinical stage I (CS-I) seminoma was also treated with CHT or RT, but in the past 2 decades practice has shifted toward active surveillance for CS-I with RT or CHT reserved for patients with progression to CS-II. Limited data exist on contemporary RT techniques and patient stratification (ie, de novo [CS-II at orchiectomy] vs relapsed [CS-II diagnosed during surveillance after orchiectomy for CS-I]). We investigated outcomes in CS-II patients treated with RT in the modern era across 2 institutions. METHODS AND MATERIALS A retrospective review identified 73 patients treated with RT for CS-II A or B seminoma between 2001 and 2022. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and univariate analyses were performed with log-rank or Cox proportional hazard regression. Recurrence was defined as biopsy-proven metastatic seminoma after RT completion. Second malignancies were defined as a biopsy-proven malignancy originating in the prior RT field. RESULTS Thirty-eight (52%) patients presented with de novo CS-II and 35 (48%) patients had relapsed CS-II. Median follow-up was 4.8 years (IQR: 2.3-8.1). Five-year RFS was 82% overall (92% in relapsed patients and 73% in de novo patients). Relapsed CS-II disease had lower recurrence rates after RT compared with de novo CS-II disease. All recurrences occurred outside the prior RT field and were salvaged. Disease-specific survival was 100%. Two second malignancies occurred (prostate, colorectal cancer at 67 months and 119 months post-RT, respectively). CONCLUSIONS In patients with CS-II seminoma treated with modern RT, there were no in-field recurrences. Presentation with de novo CS-II is associated with out-of-field recurrence. Subject to further larger-scale validation, our results suggest that compared with CS-II at time of relapse, de novo CS-II may portend more aggressive or micrometastatic disease beyond the retroperitoneum, raising the possibility of benefit from CHT after radiation.
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Affiliation(s)
- Daniel B Rosen
- Harvard Radiation Oncology Program, Boston, Massachusetts
| | - Anushka Ghosh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Clair J Beard
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Praful Ravi
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alok Tewari
- Dana Farber Cancer Institute, Boston, Massachusetts
| | - Christopher Sweeney
- South Australian Immunogenomics Cancer Institute, University of Adelaide, Adelaide, Australia
| | - Richard J Lee
- Harvard Medical School, Boston, Massachusetts; Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Philip Saylor
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Neil Martin
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kent Mouw
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts.
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3
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Rosen DB, Tan AJN, Pursley J, Kamran SC. Advances in radiation therapy for testicular seminoma. World J Urol 2023; 41:3895-3903. [PMID: 37979002 DOI: 10.1007/s00345-023-04674-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/26/2023] [Indexed: 11/19/2023] Open
Abstract
PURPOSE Novel techniques and advances in radiation therapy (RT) have been explored to treat testicular seminoma, a highly radiosensitive and curable histology. We evaluated the historical and current indications for radiation therapy (RT) in testicular seminoma. METHODS A narrative literature review was performed. Studies of RT for testicular seminoma were included. Additionally, recent trials testing the use of combination or surgical therapies for clinical stage (CS) II were included. Search parameters included radiation therapy, testicular seminoma, surgery, and chemoradiation. Parameters and outcomes assessed were progression-free survival (PFS), overall survival (OS), acute toxicities, long-term sequelae, and rates of secondary malignancies. RESULTS Practice defining and changing studies in the use or omission of radiation therapy for testicular seminoma were identified along with resultant changes in National Comprehensive Cancer Network (NCCN) and European guidelines. Recent trials in combined chemoradiation and upfront surgical approaches to CS II disease were reviewed. CONCLUSION RT has historically been used as adjuvant treatment for CS I disease and is highly effective at treating CS II (A/B) testicular seminoma. The drive to maintain therapeutic efficacy and reduce acute and long-term side effects, namely secondary malignancies, is being tested using new radiation technologies, combined modality therapy in the form of chemoradiation and with upfront surgical approaches. Also, as guidelines now "strongly prefer" surveillance instead of adjuvant RT for CS I disease, the current CS II population comprises patients presenting with CS II disease ("de novo") and those who present with CSII after relapsing post orchiectomy for CS I ("relapsed"). Emerging evidence suggests that these two groups have different outcomes with respect to RT and chemoradiation. Consequently, future trials may need to sub-stratify according to these groups.
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Affiliation(s)
| | - Arvin Jeremy N Tan
- Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA
| | - Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Papachristofilou A, Bedke J, Hayoz S, Schratzenstaller U, Pless M, Hentrich M, Krege S, Lorch A, Aebersold DM, Putora PM, Berthold DR, Zihler D, Zengerling F, Dieing A, Mueller AC, Schaer C, Biaggi C, Gillessen S, Cathomas R. Single-dose carboplatin followed by involved-node radiotherapy for stage IIA and stage IIB seminoma (SAKK 01/10): a single-arm, multicentre, phase 2 trial. Lancet Oncol 2022; 23:1441-1450. [PMID: 36228644 DOI: 10.1016/s1470-2045(22)00564-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Standard treatment options for patients with stage IIA or stage IIB seminoma include either para-aortic and pelvic radiotherapy or three to four cycles of cisplatin-based combination chemotherapy. These options result in 3-year progression free survival rates of at least 90%, but bear risks for acute and late toxic effects, including secondary malignancies. We tested a novel approach combining de-escalated chemotherapy with de-escalated involved node radiotherapy, with the aim of reducing toxicity while preserving efficacy. METHODS In the single-arm, multicentre, phase 2 SAKK 01/10 trial, patients with stage IIA or IIB classic seminoma (either at primary diagnosis or at relapse during active surveillance for stage I) were enrolled at ten centres of the Swiss Group for Clinical Cancer Research and ten centres of the German Testicular Cancer Study Group. WHO performance status 0-2, age 18 years or older, and adequate bone marrow and kidney function were required for eligibility. Treatment comprised one cycle of carboplatin (area under the curve 7) followed by involved-node radiotherapy (30 Gy in 15 fractions for stage IIA disease and 36 Gy in 18 fractions for stage IIB disease). The primary endpoint was 3-year progression-free survival. Efficacy analyses were done on the full analysis set, which comprised all patients who signed the informed consent, were registered in the trial, initiated trial treatment, and met all medically relevant inclusion or exclusion criteria. Safety was assessed in all patients who were treated at least once with one of the trial treatments. The study is ongoing but no longer recruiting, and is registered with Clinicaltrials.gov, NCT01593241. FINDINGS Between Oct 18, 2012, and June 22, 2018, 120 patients were registered in the study. 116 patients were eligible and started treatment according to the study protocol (46 patients with stage IIA disease and 70 with stage IIB disease). After a median follow-up of 4·5 years (IQR 3·9-6·0), 3-year progression-free survival was 93·7% (90% CI 88·5-96·6). With a target progression-free survival of 95% at 3 years, the primary endpoint was not met. Acute treatment-related adverse events of any grade were noted in 58 (48%) of 116 patients, and grade 3 or 4 treatment-related adverse events occurred in the form of neutropenia in five (4%) patients, thrombocytopenia in three (3%) patients, and vomiting in one (1%) patient. No treatment-related deaths and no late treatment-related adverse events were reported. Serious adverse events were reported in five (4%) of 116 patients (one transient creatinine increase and four second primary tumours). INTERPRETATION Despite the fact that the primary endpoint was not met, we observed favourable 3-year progression-free survival with single-dose carboplatin area under the curve 7 and involved-node radiotherapy, with minimal toxic effects. Our findings might warrant discussion with patients about the SAKK 01/10 regimen as an alternative to standard-of-care treatment, but more research on this strategy is needed. FUNDING Swiss State Secretariat for Education, Research and Innovation and Rising Tide Foundation for Clinical Cancer Research.
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Affiliation(s)
| | - Jens Bedke
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - Stefanie Hayoz
- Competence Center of SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | | | - Miklos Pless
- Medical Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Marcus Hentrich
- Department of Hematology and Oncology, Red Cross Hospital Munich, Munich, Germany
| | - Susanne Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Anja Lorch
- Department of Urology, University Hospital Duesseldorf, Duesseldorf, Germany; Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Daniel-M Aebersold
- Department of Radiation Oncology, University Hospital of Bern, Bern, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Dominik-R Berthold
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Deborah Zihler
- Department of Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Annette Dieing
- Department of Internal Medicine, Hematology and Oncology, Vivantes Klinikum am Urban, Berlin, Germany
| | | | - Corinne Schaer
- Competence Center of SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Christine Biaggi
- Competence Center of SAKK-Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Silke Gillessen
- Istituto Oncologico della Svizzera Italiana, Ente Ospedaliero Cantonale Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Richard Cathomas
- Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
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Fatigante L, Ducci F, Campoccia S, Nocita AM, Paci E, Crocetti E, Cionini L. Long-Term Results in Patients Affected by Testicular Seminoma Treated with Radiotherapy: Risk of Second Malignancies. Tumori 2019; 91:144-50. [PMID: 15948542 DOI: 10.1177/030089160509100208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims To report clinical results in patients with testicular seminoma treated with postoperative radiotherapy with regard to survival, acute and late toxicity, and risk of second malignancy. Materials and methods 176 stage I-II testicular seminoma patients treated with radiotherapy from 1964 to 1994 at the Radiotherapy Division of Pisa University, using 60Co or Linac, were analyzed retrospectively. The follow-up ranged from 0.13 to 32.37 years, with a median of 12.1 years. The observed numbers of second malignancies were compared with those expected, taking into account age, sex, and incidence rates from the Tuscany Tumor Registry. Results Overall and specific survival at 10-15 years were 89-82% and 93-92%, respectively. Multivariate analysis revealed a significantly better survival in patients younger than 50 years and in those treated with Linac. Severe late sequelae occurred in 8% of the patients. Sixteen second malignancies were observed (14 solid tumors and 2 leukemias); median latency was 13 years (range, 3-27) and the observed/expected ratio 1.4 ( P not significant). Solid cancers were localized in the bladder (2), kidney (2), skin (2), stomach (1), prostate (1), lung (1), larynx (1), uvea (1) and contralateral testicle (1); 1 patient presented an intestinal carcinoid and 1 a metastasis from an unknown primary. The risk of a second malignancy was higher in the patient group receiving less than 4000 cGy (observed/expected, 2.8; P = 0.015). Conclusions The study confirmed the high cure rate in stage III seminomas after postoperative radiotherapy. Incidence of a second malignancy was higher than expected, but the difference was not statistically significant.
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Affiliation(s)
- Lucia Fatigante
- Radiotherapy Division, Oncology Department, University of Pisa, Italy.
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7
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Tana S, Cerrotta A, Gardani G, Palazzi M, Pizzocaro G. Postsurgical Policy in Stage I Testicular Seminoma: Cost and Benefit of Prophylactic Irradiation in a Long-term Experience. Tumori 2018; 83:918-21. [PMID: 9526584 DOI: 10.1177/030089169708300609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The definitive cure rate for clinical stage I testicular seminoma is very close to 100%, and prophylactic irradiation of the regional lymph nodes is associated with a low morbidity. Nevertheless, in recent years a “wait-and-see” policy has been proposed by some researchers. We analysed the cost/benefit ratio of radiotherapy (RT) by review of the case histories of 299 patients treated at the Department of Radiotherapy of the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan from January 1968 to December 1989. The 5-year overall survival was 99% (97.5% at 10 years), while the 10-year disease-free survival was 96%. The recurrence rate was 2.3%, but no patient relapsed in the irradiated areas. Acute toxicity was very moderate with only 4 (1.3%) serious radiation sequelae occurring 6 to 27 years after treatment. However, 9 second malignancies (3%) were observed. Lastly, we have calculated the costs for our National Health Service comparing surveillance policy and prophylactic irradiation.
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Affiliation(s)
- S Tana
- Department of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy
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8
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Amichetti M, Fellin G, Bolner A, Busana L, Pani G, Romano M, Scillieri M, Maluta S. Stage I Seminoma of the Testis: Long Term Results and Toxicity with Adjuvant Radiotherapy. Tumori 2018; 80:141-5. [PMID: 8016907 DOI: 10.1177/030089169408000212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Pure testicular seminoma has historically been treated with post-orchidectomy radiation therapy with excellent results. Recently, several aspects of the treatment of stage I seminoma have been questioned. We assessed long-term results and toxicity of patients with pure testicular seminoma treated at the Department of Radiation Oncology of S. Chiara Hospital, Trento. Methods From 1953 to 1987, 102 patients with stage I pure testicular seminoma were given megavoltage irradiation with curative intent. All patients had a minimum follow-up of 3 years (maximum 37 years, median 13 years). They received a mean para-aortic/pelvic dose of 33.07 Gy (range 23.70-45.20 Gy) with different doses and fields reflecting the change in techniques over a long period of time. Results The cause-specific actuarial survival at 30 years was 99% and crude survival 67%. One patient had an out-field relapse (inguinal) after a few months and was cured with radiotherapy and chemotherapy. Another patient relapsed with widespared metastases and died after 1 year of progressive disease. Early toxycity was mild and the treatment was well tolerated. Late side effects were reported in 8/102 patients. Conclusion In our series adjuvant radiation therapy resulted in cure rates corresponding to those reported in the literature. The 30-year actuarial survival of 99% was extremely good and the toxicity of the treatment was mild. Post-orchidectomy radiation to the para-aortic and ipsilateral pelvic nodes is a safe and effective method of preventing recurrences and is currently to be considered the treatment of choice in stage I testicular seminoma.
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Affiliation(s)
- M Amichetti
- U.O. di Radioterapia Oncologica, Ospedale S. Chiara, Trento, Italy
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9
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Stein ME, Leviov M, Drumea K, Goralnik L, Miselevich I, Kuten A. Radiation-Induced Sarcoma following Curative Radiotherapy for Testicular Seminoma: Case Report and Brief Review of the Literature. Tumori 2018; 83:721-3. [PMID: 9267497 DOI: 10.1177/030089169708300320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of radiation-induced retroperitoneal leiomyosarcoma which developed 37 years after the patient received radiation therapy for testicular seminoma. The sarcoma originated within the para-aortic field, extensively involving neighboring organs, soft tissue and muscle tissues, and could be only partially resected. The absolute number of these secondary sarcomas is low, but the risk of developing such neoplasms calls for awareness in the long-term follow-up of cured seminoma patients.
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Affiliation(s)
- M E Stein
- Northern Israel Oncology Center, Rambam Medical Center, Haifa, Israel
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10
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Lieng H, Chung P, Lam T, Warde P, Craig T. Testicular seminoma: Scattered radiation dose to the contralateral testis in the modern era. Pract Radiat Oncol 2018; 8:e57-e62. [PMID: 29306641 DOI: 10.1016/j.prro.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/05/2017] [Accepted: 10/05/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Limited data exist on testicular dose measurements using modern radiation treatment techniques and volumes for testicular seminoma. The aim of this study was to report the testicular dose using in vivo measurements in men with testicular seminoma receiving abdominopelvic radiation therapy (APRT) and a modified dog-leg field with and without gonadal shielding. METHODS AND MATERIALS Men with histologically confirmed testicular seminoma, either newly diagnosed stage II disease or isolated retroperitoneal relapse on surveillance for stage I disease, treated with APRT had testicular dose measurements recorded using MOSFET dosimeters. Those patients wishing to preserve fertility underwent radiation treatment with daily gonadal shielding. Factors that may influence testicular dose including field size, distance of the remaining testis from the radiation field, and patient separation, were also measured. RESULTS Measurements were performed for 16 men; 10 with gonadal shielding and 6 without. The mean measured dose to the testis in the patients with gonadal shielding was 2.6 cGy (standard error, 0.75; range, 0-13) compared with 28.6 cGy (standard error, 12.6; range, 0-86) in the unshielded group for a 20-fraction treatment. CONCLUSIONS The use of gonadal shielding during APRT with a modified dog-leg technique results in a low testicular dose that is below the likely threshold for impaired spermatogenesis. In those men wishing to preserve fertility, we recommend the use of gonadal shielding, even with the use of modern radiation therapy techniques.
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Affiliation(s)
- Hester Lieng
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada.
| | - Tony Lam
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Padraig Warde
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Bolm L, Janssen S, Bartscht T, Rades D. Radiotherapy Alone for Malignant Spinal Cord Compression in Young Men with Seminoma. Anticancer Res 2016; 36:2033-2034. [PMID: 27069198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/08/2016] [Indexed: 06/05/2023]
Abstract
AIM Seminomas are very radiosensitive tumors. Therefore, patients with malignant spinal cord compression (MSCC) from seminoma may not require for neurosurgery in addition to radiotherapy. In this study, radiotherapy alone was evaluated in young men with MSCC from seminoma. PATIENTS AND METHODS Four young men with MSCC due to vertebral lesions from metastatic seminoma received radiotherapy alone. The impact of radiotherapy on motor function and gait function, local control of MSCC and survival were retrospectively evaluated. RESULTS All patients showed improvement of motor function following irradiation. All patients who were not able to walk prior to radiotherapy regained their walking ability. One-year and two-year local control rates were 100% and 100%, respectively. Survival rates at one and two years were 75% and 75%, respectively. CONCLUSION Radiotherapy alone resulted in excellent outcomes. If clear indications for neurosurgery are not given, radiotherapy alone can be considered the treatment of choice for patients with MSCC from seminoma.
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Affiliation(s)
- Louisa Bolm
- Department of Radiation Oncology and Hematology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology and Hematology, University of Lübeck, Lübeck, Germany
| | - Tobias Bartscht
- Department of Oncology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology and Hematology, University of Lübeck, Lübeck, Germany
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Nakfoor BM, Shipley WU, Zietman AL. Early stage testicular seminoma: the role of radiation therapy following orchiectomy. Front Radiat Ther Oncol 2015; 28:183-95. [PMID: 7982596 DOI: 10.1159/000423383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- B M Nakfoor
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston
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13
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Haque W, Wages C, Zhu XR, Choi S, Pugh TJ, Frank SJ, Lee A, Mahmood U. Proton therapy for seminoma: Case report describing the technique, efficacy, and advantages of proton-based therapy for seminoma. Pract Radiat Oncol 2015; 5:135-40. [PMID: 25413401 DOI: 10.1016/j.prro.2014.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/15/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, Texas
| | - Cody Wages
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - X Ronald Zhu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seungtaek Choi
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Usama Mahmood
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
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Abstract
PURPOSE To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. MATERIALS AND METHODS Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). RESULTS With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. CONCLUSION Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.
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Affiliation(s)
- Hayoon Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Choul Yang
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
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15
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Matsumoto Y, Umezu Y, Fujibuchi T, Noguchi Y, Fukunaga J, Kimura T, Hirano N, Hirose T, Sonoda S, Matsumoto R. [Verification of the protective effect of a testicular shield in postoperative radiotherapy for seminoma]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:883-887. [PMID: 25242597 DOI: 10.6009/jjrt.2014_jsrt_70.9.883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In postoperative radiotherapy for seminoma, control of the testicular absorbed dose is important, since exposure of the testis can lead to temporary or permanent infertility. In this case, instead of using a dog-leg-shaped field, treatment using a field focused near the aorta was provided in several disease stages of seminoma. However, the precise need for testicular shielding during treatment and dose of testis exposure was not clear. We examined these questions by measuring the testicular absorbed dose with and without a testicular shield using two clinical treatment plans and a phantom. The distance from the testis phantom and the lower end of the irradiation field was varied. Where the total dose for the tumor was 20 Gy, the testicular absorbed dose was below 0.1 Gy, the threshold dose for temporary infertility. At this dosage, the distance between the testis phantom and the edge of the irradiation field was 14.6 cm without the shield and 9.99 cm with the shield. Using a testes shield, it was thus possible to reduce the dose by 58.5%.
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Affiliation(s)
- Yoshitsugu Matsumoto
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital
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16
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Haugnes HS, Solhaug Ø, Stenberg J, Hjelle LV, Bremnes RM. Seminoma patients treated at a minor oncological department during 1986-2010: treatment and outcome. Anticancer Res 2014; 34:4253-4260. [PMID: 25075055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To present results for patients with seminoma treated at our University Clinic. PATIENTS AND METHODS All men treated for seminoma in 1986-2010 at the Department of Oncology, University Hospital of North Norway were included (n=232). Treatment was standardized from 2000 as the Swedish and Norwegian Testicular Cancer Project (SWENOTECA) published their first standardised seminoma treatment program (SWENOTECA V). RESULTS The percentage of patients administered adjuvant radiotherapy (RT) for clinical stage (CS) I decreased gradually from the late 1990s and was abandoned in 2005. Surveillance was the most common management strategy for CS I after 2000. Overall, disease in 1.9% and 11% of patients relapsed after adjuvant RT and surveillance, respectively. There were no relapses after treatment for metastatic disease. Cancer-specific survival was 100%, and overall survival 95% for the total group. CONCLUSION The treatment outcome at our University Clinic is excellent with 100% cancer-specific survival, and is essentially a result of the bi-national SWENOTECA network.
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Affiliation(s)
- Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Øivind Solhaug
- Department of Medicine, Nordland Hospital Lofoten, Leknes, Norway
| | - Johannes Stenberg
- Department of Medicine, Nordland Hospital Vesterålen, Stokmarknes, Norway
| | - Line V Hjelle
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Roy M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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17
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Sabzi F, Faraji R. Radiation induced myxoma of superior vena cava origin presenting as a right atrial mass. JNMA J Nepal Med Assoc 2014; 52:952-954. [PMID: 26982674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Myxomas are the most common benign cardiac tumors. Myxomas are more common in the left heart chamber than the right side chamber. An extracardiac origin presenting as a right atrial mass is very rare. Right-sided tumors are considerably less common than left-sided tumors, and however myxoma of great vessels origin presenting as right atrial masses are rare but radiation induced villous myxoma in superior vena cava (SVC) is exceedingly rare tumor. A case of radiation induced myxoma originating in a previously undescribed location and presenting as a right atrial mass is reported.
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Affiliation(s)
- F Sabzi
- Department of Cardiovascular Surgery, Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - R Faraji
- Department of Cardiovascular Surgery, Imam Ali Heart Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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18
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Horwich A, Fossa SD, Huddart R, Dearnaley DP, Stenning S, Aresu M, Bliss JM, Hall E. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer 2014; 110:256-63. [PMID: 24263066 PMCID: PMC3887279 DOI: 10.1038/bjc.2013.551] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/02/2013] [Accepted: 08/14/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant. METHODS We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51,151 person-years of follow-up. RESULTS Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47-1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39-1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic-abdominal sites the SIR was 1.62 (95% CI: 1.43-1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98-1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30-1.65, P<0.0001). CONCLUSION The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers.
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Affiliation(s)
- A Horwich
- Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK
| | - S D Fossa
- Norwegian Radium Hospital, Oslo, Norway
| | - R Huddart
- Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK
| | - D P Dearnaley
- Academic Radiotherapy Unit, The Institute of Cancer Research and the Royal Marsden NHS Trust, 123 Old Brompton Rd, London SW7 3RP, UK
| | - S Stenning
- The Medical Research Council Clinical Trials Unit, Aviation House, 125 Kingsway, London WC2B 6NH, UK
| | - M Aresu
- The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK
| | - J M Bliss
- The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK
| | - E Hall
- The Clinical Trials and Statistics Unit, The Institute of Cancer Research, 123 Old Brompton Rd, London SW7 3RP, UK
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19
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Nesterova ES, Mangasarova IK, Bariakh EA, Gubkin AV, Tolstykh TN, Lukina AI, Kovrigina AM, Domracheva EV, Chernova NG, Mar'in DS, Zvonkov EE, Gemdzhian ÉG, Kravchenko SK. [Experience with high-dose chemotherapy in patients with testicular diffuse large B-cell lymphoma]. TERAPEVT ARKH 2014; 86:59-67. [PMID: 25314779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To evaluate the efficiency of high-dose therapy according to the DLBL-CNS-2007 protocol in patients with testicular diffuse large B-cell lymphoma (DLBL). SUBJECTS AND METHODS Out of 408 male patients with non-Hodgkin lymphoma, 8 patients aged 50 to 69 years (median age 55.5 years) with primary testicular (n=3) or with generalized-stage testicular DLBL (n=5) were included in the study. These patients were followed up at the Hematology Research Center, Ministry of Health of the Russian Federation, in 2007 to 2013. Systemic chemotherapy was performed in accordance with the DLBL-CNS-2007 protocol. RESULTS The DLBL-CNS-2007 protocol was implemented in first-line therapy in 7 patients. At the first diagnostic stage, one patient was found to have anaplastic seminoma; in this connection right orchifuniculectomy was carried out, followed by radiotherapy applied to the scrotal region in a total focal dose of 34 Gy. This patient with disease recurrence was included in the DLBL-CNS-2007 treatment protocol. The number of polychemotherapy (PCT) cycles (n=4 or 6) was determined by the time to achieve complete remission. After completion of DLBL-CNS-2007 PCT, 6 patients achieved complete remission; the primary resistant disease was noted in 2 cases. At this moment 6 patients are alive in first complete remission during the median follow-up of 50 months (10-54 months). CONCLUSION The findings suggest that high-dose therapy according to the DLBL-CNS-2007 protocol in patients with testicular DLBL can achieve complete remission and increase overall and event-free survival rates. This fact should be borne out by a large number of observations.
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20
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Thong AE, Lichtensztajn DY, Almario L, Ingels A, Gomez SL, Gonzalgo ML. Stage I testicular seminoma: a SEER analysis of contemporary adjuvant radiotherapy trends. J Urol 2013; 190:1240-4. [PMID: 23567749 DOI: 10.1016/j.juro.2013.03.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80% of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100%. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. MATERIALS AND METHODS A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. RESULTS The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7% of patients received radiation, compared with only 37.7% of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95% CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95% CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95% CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. CONCLUSIONS The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.
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Affiliation(s)
- Alan E Thong
- Department of Urology, Stanford University School of Medicine, Stanford, California
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21
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Arvold ND, Catalano PJ, Sweeney CJ, Hoffman KE, Nguyen PL, Balboni TA, Fosså SD, Travis LB, Beard CJ. Barriers to the implementation of surveillance for stage I testicular seminoma. Int J Radiat Oncol Biol Phys 2012; 84:383-9. [PMID: 22349043 DOI: 10.1016/j.ijrobp.2011.11.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/15/2011] [Accepted: 11/17/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE Postorchiectomy adjuvant radiotherapy (RT) for Stage I seminoma can be associated with long-term toxicity, and management strategies with a lower treatment burden achieve the same excellent cure rate. Because studies suggest that radiation oncologists in the United States continue to recommend RT for these patients, we sought to identify factors associated with management recommendations. METHODS AND MATERIALS We conducted a one-time internet-based survey among 491 randomly selected American radiation oncologists self-described as specializing in genitourinary oncology. RESULTS Response rate was 53% (n = 261). Forty-nine percent of respondents worked in university-affiliated practices. Sixty-two percent of respondents always/usually recommended adjuvant RT for patients with Stage I seminoma, whereas 21% always/usually recommended surveillance and 3% always/usually recommended chemotherapy. One third (33%) expressed concerns that patients who experienced relapse during surveillance could not be salvaged. Although 88% of physicians were aware of an increased risk of second malignant neoplasms (SMN) after adjuvant RT, 85% underestimated its magnitude. Compared with physicians not typically recommending RT, physicians who always/usually recommended RT were more likely to believe that patients might not be salvaged at relapse during surveillance (p = 0.008) and were less aware of the association between RT and SMN (p = 0.04). CONCLUSIONS Respondents who always/usually recommend postorchiectomy RT for patients with Stage I seminoma are more likely to underestimate late RT morbidity and to believe that surveillance is associated with increased mortality. Given the equivalent efficacy and reduced morbidity of surveillance compared with RT, our findings underscore the need for ongoing physician education to increase appropriate clinical implementation of surveillance strategies.
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Affiliation(s)
- Nils D Arvold
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA
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22
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Wang JL, Yu H, Guo Y, Hu XC, Pan ZQ, Chang JH, Zhang YW. A single institution, retrospective study of treatment experience in primary mediastinal germ cell tumors: elucidating the significance of systemic chemotherapy. Chin Med J (Engl) 2012; 125:626-630. [PMID: 22490486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Primary malignant germ cell tumors (GCTs) of mediastinum are rare neoplasms. We introduce our institutional experience in managing patients with primary malignant GCTs of the mediastinum, focusing on the analysis of therapeutic modalities. METHODS A retrospective review was done in 39 consecutive patients with mediastinal malignant GCTs treated in our institution between 1991 and 2007. RESULTS A total of 39 patients were enrolled in this study with a median age of 27 years. The 5-year overall survival (OS) and progression-free survival (PFS) rates of the whole population were 60.2% and 57.7%, respectively. Stratified by the histology, 18 patients (46.2%) had seminoma and 21 patients (53.8%) had nonseminomatous germ cell tumors (NSGCTs). The 5-year OS rate of patients with seminoma was 87.4% as compared with 36.7% in patients with NSGCTs (P = 0.0004). The 5-year PFS rate was also significantly higher in seminoma patients (87.4% vs. 31.6%, P = 0.003). For 19 patients with NSGCTs managed with multi-modality treatment, chemotherapy exposure appeared to impact the prognosis. The 5-year OS rate was 44.9% in patients with chemotherapy exposure as compared with 20.0% in patients without it (P = 0.43). CONCLUSION Our study confirmed the significance of systemic chemotherapy in the treatment of primary mediastinal GCTs.
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Affiliation(s)
- Jia-lei Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, China
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Mahantshetty U, Banerjee S, Kakkar S, Murthy V, Bakshi G, Tongaonkar HB, Shrivastava S. Treatment of Stage I Seminoma testis with extended field adjuvant radiation. Gulf J Oncolog 2012:20-24. [PMID: 22227541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2011] [Indexed: 05/31/2023]
Abstract
With an aim to analyze and document the outcome of Stage I Seminoma patients we undertook a retrospective analysis of patients treated between January 1990 and December 1998. The treatment charts of patients treated between January 1990 and December 1998 were reviewed. Patient and tumor characteristics, treatment details, relapse rates, late toxicities, or occurrence of second primary was noted. Royal Marsden Staging System was utilized because of its simplicity and wide-use in the above period. Out of 137 patients, 41 (30%) patients did not receive any further treatment, 96 (70%) patients received prophylactic radiotherapy to para-aortic and pelvic nodes. The observation group patients had a median follow-up 20 months, 9 patients had nodal relapse with 7 in retroperitoneal nodes and 2 patients in inguinal nodes. Of these, 7 patients received BEP chemotherapy and 2 patients Chemoradiation. Four patients had complete remission while remaining 5 patients had partial response. The histopathologies of all the 5 patients with partial response were reviewed to reconfirm the diagnosis. Patients of prophylactic radiotherapy group had a follow-up of 33 months, 6 patients relapsed, RP nodal disease in 5 patients and distant metastasis in 1 patient. All these patients received BEP chemotherapy. One had complete response and remaining 5 patients had partial response. The group of patients under observation had a significantly higher relapse rate and lower disease free compared to the adjuvant radiotherapy group (73.5% vs. 91% at five years, p value 0.004). Disease specific survivals for the two groups were however similar (89% vs. 93%) at five years, p value 0.18). We conclude that Stage I Seminoma patients treated with prophylactic radiation to paraaortic and pelvic region had better outcome.
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Affiliation(s)
- U Mahantshetty
- Department of Radiation Oncology and Uro-Oncology, Tata Memorial Centre, Mumbai, India.
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Nasr E, Helou J, Nehmé Nasr D, Younes JG, Nemr E, Moukarzel M, Azoury F, Merhej S. [Tolerance of adjuvant radiotherapy in the treatment of stage I seminoma]. J Med Liban 2011; 59:202-205. [PMID: 22746008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess the tolerance of adjuvant radiotherapy in the treatment of stage I seminoma post-orchiectomy. MATERIAL AND METHODS Between 2001 and 2006, 21 men with stage I seminoma underwent 3D conformal radiotherapy 3 to 4 weeks post-orchiectomy. The total radiation dose was 2490 cGy divided into 15 sessions. Radiation was delivered by 2 antero-posterior fields using X-ray photons of 18 MV. Two types of radiation fields were used : para-aortic and ipsilateral iliac (dog leg) or para-aortic only. The average followup was 2 years 4 months with an interval of 4 to 58 months. Tolerance of treatment was evaluated according to criteria of the RTOG. RESULTS Median follow-up time is 30 months. Disease-free survival was 100%. The most frequently encountered acute toxicity was gastrointestinal; mainly nausea and vomiting. Tolerance to treatment was better in the group receiving para-aortic radiotherapy alone (37% of grade II gastrointestinal toxicity vs 62%) CONCLUSION The para-aortic irradiation for stage I seminoma gave satisfactory results with a better toxicity profile than the dogleg irradiation.
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Affiliation(s)
- Elie Nasr
- Service de Radiothérapie, CHU Hôtel-Dieu de France, Beyrouth, Liban.
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Dieckmann KP, Matthies C, Kliesch S. Carboplatin does not prevent contralateral testicular tumors in patients with seminoma. J Clin Oncol 2011; 29:2944-5; author reply 2945-6. [PMID: 21670458 DOI: 10.1200/jco.2011.35.7970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zilli T, Boudreau C, Doucet R, Alizadeh M, Lambert C, van Nguyen T, Taussky D. Bone marrow-sparing intensity-modulated radiation therapy for Stage I seminoma. Acta Oncol 2011; 50:555-62. [PMID: 21413852 DOI: 10.3109/0284186x.2011.564650] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A direct association between radiotherapy dose, side-effects and secondary cancers has been described in patients with seminoma. A treatment planning study was performed in order to compare computed tomography-based traditional radiotherapy (CT-tRT) versus bone marrow-sparing intensity-modulated radiation therapy (BMS-IMRT) in patients with Stage I seminoma. MATERIAL AND METHODS We optimized in 10 patients a CT-tRT and a BMS-IMRT treatment plan to deliver 20 Gy to the para-aortic nodes. CT-tRT and IMRT consisted of anteroposterior-posterioranterior parallel-opposed and seven non-opposed coplanar fields using 16 and 6-MV photon energies, respectively. Dose-Volume Histograms for clinical target volume (CTV), planning target volume (PTV) and organs at risk (OARs) were compared for both techniques using Wilcoxon matched-pair signed rank-test. RESULTS D(mean) to CTV and PTV were similar for both techniques, even if CT-tRT showed a slightly improved target coverage in terms of PTV-D(95%) (19.7 vs. 19.5 Gy, p = 0.005) and PTV-V(95%) (100 vs. 99.7%, p = 0.011) compared to BMS-IMRT. BMS-IMRT resulted in a significant reduction (5.2 Gy, p = 0.005) in the D(mean) to the active bone marrow (ABM). The V(100%) and V(75%) of the OARs were reduced with BMS-IMRT by: ABM-V(100%) = 51.7% and ABM-V(75%) = 42.3%; bowel-V(100%) = 15.7% and bowel-V(75%) = 16.8%; stomach-V(100%) = 22% and stomach-V(75%) = 27.7%; pancreas-V(100%) = 37.1% and pancreas-V(75%) = 35.9% (p = 0.005 for all variables). CONCLUSIONS BMS-IMRT reduces markedly the dose to the OARs compared to CT-tRT. This should translate into a reduction in acute and long-term toxicity, as well as into the risk of secondary solid and hematological cancers.
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Affiliation(s)
- Thomas Zilli
- Department of Radiation Oncology, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Hôpital Notre Dame, Montréal, Québec, Canada
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Chung P, Warde P. Testicular cancer: seminoma. BMJ Clin Evid 2011; 2011:1807. [PMID: 21477387 PMCID: PMC3217763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 25 to 35 years. Most testicular cancers are germ cell tumours and half of these are seminomas, which tend to affect older men and have a good prognosis. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in men with stage 1 seminoma (confined to testis) who have undergone orchidectomy? What are the effects of treatments in men with good-prognosis non-stage 1 seminoma who have undergone orchidectomy? What are the effects of maintenance chemotherapy in men who are in remission after orchidectomy and chemotherapy for good-prognosis non-stage 1 seminoma? What are the effects of treatments in men with intermediate-prognosis seminoma who have undergone orchidectomy? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 29 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review, we present information relating to the effectiveness and safety of the following interventions: chemotherapy (maintenance, adjuvant, single-agent carboplatin, 3 or 4 cycles, different number of cycles of adjuvant, using bleomycin added to vinblastine plus cisplatin, using etoposide plus cisplatin with or without bleomycin, adding higher doses to a 2-drug chemotherapy regimen using cisplatin or vinblastine); radiotherapy (different adjuvant regimens [20 Gy in 10 fractions to para-aortic area, 30 Gy in 15 fractions to para-aortic area and iliac nodes], different drug combinations, 30-36 Gy in 15-18 fractions); and surveillance.
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Affiliation(s)
- Peter Chung
- Radiation Medicine Program, Princess Margaret Hospital, Assistant Professor, Radiation Oncology, University of Toronto, Toronto, Canada
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Simone CB, Kramer K, O'Meara WP, Bekelman JE, Belard A, McDonough J, O'Connell J. Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma. Int J Radiat Oncol Biol Phys 2011; 82:242-9. [PMID: 21236595 DOI: 10.1016/j.ijrobp.2010.11.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 11/07/2010] [Accepted: 11/22/2010] [Indexed: 01/22/2023]
Abstract
PURPOSE Photon radiotherapy has been the standard adjuvant treatment for stage I seminoma. Single-dose carboplatin therapy and observation have emerged as alternative options due to concerns for acute toxicities and secondary malignancies from radiation. In this institutional review board-approved study, we compared photon and proton radiotherapy for stage I seminoma and the predicted rates of excess secondary malignancies for both treatment modalities. METHODS AND MATERIAL Computed tomography images from 10 consecutive patients with stage I seminoma were used to quantify dosimetric differences between photon and proton therapies. Structures reported to be at increased risk for secondary malignancies and in-field critical structures were contoured. Reported models of organ-specific radiation-induced cancer incidence rates based on organ equivalent dose were used to determine the excess absolute risk of secondary malignancies. Calculated values were compared with tumor registry reports of excess secondary malignancies among testicular cancer survivors. RESULTS Photon and proton plans provided comparable target volume coverage. Proton plans delivered significantly lower mean doses to all examined normal tissues, except for the kidneys. The greatest absolute reduction in mean dose was observed for the stomach (119 cGy for proton plans vs. 768 cGy for photon plans; p < 0.0001). Significantly more excess secondary cancers per 10,000 patients/year were predicted for photon radiation than for proton radiation to the stomach (4.11; 95% confidence interval [CI], 3.22-5.01), large bowel (0.81; 95% CI, 0.39-1.01), and bladder (0.03; 95% CI, 0.01-0.58), while no difference was demonstrated for radiation to the pancreas (0.02; 95% CI, -0.01-0.06). CONCLUSIONS For patients with stage I seminoma, proton radiation therapy reduced the predicted secondary cancer risk compared with photon therapy. We predict a reduction of one additional secondary cancer for every 50 patients with a life expectancy of 40 years from the time of radiation treatment with protons instead of photons. Proton radiation therapy also allowed significant sparing of most critical structures examined and warrants further study for patients with seminoma, to decrease radiation-induced toxicity.
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Affiliation(s)
- Charles B Simone
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Tan GH, Azrif M, Shamsul AS, Ho CCK, Praveen S, Goh EH, Bahadzor B, Ismail F, Zulkifli MZ. Clinicopathological features and survival of testicular tumours in a Southeast Asian university hospital: a ten-year review. Asian Pac J Cancer Prev 2011; 12:2727-2730. [PMID: 22320982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Testicular cancer mainly affects young men worldwide. There is lack of published data on patients with this malignant condition from the Southeast Asian region. The aim of this study was therefore to determine the clinicopathologic features of testicular cancer patients treated in a Southeast Asian university hospital and their overall survival rate. MATERIALS AND METHODS This was a retrospective study of testicular cancer patients treated between January 2001 and February 2011. Their epidemiological data, clinical presentation, pathologic diagnosis, stage of disease and treatment were gathered and the overall survival rate of this cohort was analyzed. RESULTS Thirty-one patients were included in this study. The majority of them were of Malay ethnicity. The average age at presentation was 33.7 years. The commonest testicular cancer was non-seminomatous germ cell tumour, followed by seminoma, lymphoma and rhabdomyosarcoma. More than half of all testicular germ cell tumour (GCT) patients had some form of metastasis at diagnosis. All the patients were treated with radical orchidectomy. Adjuvant chemotherapy was given to those with metastatic disease. Four seminoma patients received radiotherapy to the para-aortic lymph nodes. The 5-year survival rate for all testicular cancers in this cohort was 83.9%. The survival rate was 88.9% in 5 years when GCT were analyzed separately. CONCLUSION GCT affects patients in their third and fourth decades of life while lymphoma patients are generally older. Most of the patients treated for GCT are of Malay ethnicity. The majority have late presentation for treatment. The survival rate of GCT patients treated here is comparable to other published series in other parts of the world.
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Affiliation(s)
- G H Tan
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Gamulin M, Kopjar N, Grgić M, Ramić S, Viculin T, Petković M, Garaj-Vrhovac V. Cytogenetic follow-up in testicular seminoma patients exposed to adjuvant radiotherapy. Coll Antropol 2010; 34:455-465. [PMID: 20698117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Early stage testicular seminoma is a radiosensitive tumor. Its incidence has significantly increased during the last decade especially in the young population. Although the therapy for testicular seminoma gives very satisfying results, the evaluation of genome damage caused by the therapy is of a great importance in order to recognize possible related health risks. The present study was performed on ten patients diagnosed with seminoma stage I; pT1/2N0M0S0, treated with adjuvant radiotherapy (a radiation dose of 25 Gy divided in 16 fractions) after orchidectomy. To assess the possible existence of an increased baseline DNA/chromosome damage in patients we also selected the appropriate control group often healthy men. The levels of primary DNA/chromosome damage in peripheral blood lymphocytes, as well as the dynamics of their repair were studied using the alkaline comet assay, chromosome aberration and cytokinesis-block micronucleus assay. Altogether four blood samples per patient were collected in the course of the therapy: before and after receiving the first dose of radiotherapy, in the middle of the radiotherapy cycle, and after the last dose of radiotherapy. Other two follow-up blood samples were collected six and twelve months after the cessation of therapy. As observed, the administration of the first radiation dose significantly increased the levels of DNA damage in almost all patients compared to their baseline values. Specific patterns of DNA damage were recorded in samples analyzed in the middle of radiotherapy and after receiving the last dose, indicating the possibility of an adaptive response in some patients. The levels of chromosomal aberrations and the incidence of micronuclei also increased in the course of therapy but gradually declined during the follow-up period. Our results confirmed the existence of post-irradiation damage in peripheral blood lymphocytes (and possibly in other non-target cells) of cancer patients which may represent a risk for the secondary cancer development. Considering that the majority of patients with testicular cancer are of a younger age, they represent a population deserving special attention. As cytogenetic screening may detect high-risk individuals, it might be useful in regular medical monitoring of seminoma patients after the successful therapy.
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Affiliation(s)
- Marija Gamulin
- Department of Oncology, Zagreb University Hospital Center, Zagreb, Croatia.
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31
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Schmidt F, Cathomas R, Stallmach T, Putora PM, Mueller J. Have you ever heard of hibernoma? A rare but important pitfall in FDG-PET/CT. Nuklearmedizin 2010; 49:N71-N73. [PMID: 21140031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/23/2010] [Indexed: 05/30/2023]
Affiliation(s)
- F Schmidt
- Department of Nuclear Medicine, Kantonspital St.Gallen, Switzerland
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32
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Zhang XQ, Liu ZW, Zhou FJ, Han H, Qin ZK, Ye YL, Li YH, Hou GL, Zhang ZL. [Experience of the treatment for clinical Stage-1 seminoma over a period of 10 years]. Chin J Cancer 2010; 29:98-101. [PMID: 20038319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with clinical stage I seminoma accounts for 70%-80% of patients with this disease. This study was to analyze the relationship between different therapeutic methods and the prognosis of this disease. METHODS The data of all patients with clinical Stage I seminoma treated by multi-disciplinary approach from 1999 to 2008 in Sun Yat-sen University Cancer Center were analyzed. The patients were divided into 3 groups based on the treatment they received after orchiectomy: 30 patients treated with chemotherapy, 8 with radiotherapy, and 20 under surveillance. The prognosis of different treatment groups was evaluated. RESULTS Among the 58 patients with stage I seminoma, 57 were followed up successfully. The median follow-up time was 50 months (range, 8-115 months). No relapse or metastasis was seen in the chemotherapy group. One patient relapsed in the radiotherapy group. Four patients had metastasis of retroperitoneal lymph node in the surveillance group. The disease-free survival was higher in the chemotherapy group than that in the surveillance group (P=0.005). There was no significant difference in the relapse-free survival between the surveillance group and the radiotherapy group (P=0.364). CONCLUSIONS Chemotherapy is a safe and effective treatment for patients with Stage-1 seminoma after radical orchidectomy.
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Affiliation(s)
- Xue-Qi Zhang
- State Key Laboratory of Oncology, South China,Guangzhou, Guangdong 510060, People's Republic of China
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Lawrentschuk N, Fleshner NE. Therapeutic options following orchiectomy for stage I seminoma. Oncology (Williston Park) 2009; 23:749-753. [PMID: 19777758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Stage I seminoma represents the paradigm of a curable malignancy, with survival of 100% an expected outcome no matter what treatment option is chosen. However, consensus has not been reached among urologists and oncologists regarding the optimal postoperative management in men with clinical stage I testicular seminoma. Currently, men are offered active surveillance, adjuvant radiation therapy, or single-agent chemotherapy. Active surveillance is associated with an 80% chance of no relapse, with all such events salvageable. Radiotherapy has an almost universal cure rate but has the potential for long-term toxicities and an overtreatment rate of about 80%. Chemotherapy efficacy and toxicity data are still immature. Recent guidelines recognize that the options of surveillance, chemotherapy, and radiotherapy are appropriate in the treatment of patients with clinical stage I seminoma. We believe active surveillance to be the best option, then radiotherapy (considering the efficacy and safety data), with single-agent chemotherapy emerging as a possible alternative.
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Affiliation(s)
- Nathan Lawrentschuk
- Division of Urologic Oncology, University of Toronto, University Health Network, Princess Margaret Hospital, Toronto, Ontario, Canada
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Abstract
An analysis was performed to determine whether a cranial reduction of the portals to the T11/T12 junction instead of the common T10/T11 junction would alter the outcome of patients with stage I seminoma. Of 163 consecutive patients with newly diagnosed testicular seminoma referred to the authors' institution between April 1992 and April 1999, 80 patients with stage I seminoma were treated with cranially reduced para-aortic treatment fields reaching from the top of T12 to the bottom of L4. Median total dose was 20.0 Gy (range, 19.8-27.2 Gy). Patients were followed-up by the use of CT in regular intervals. After a median follow-up of 7.1 years (range, 4.1-11.1 years), four patients (5%) had relapsed resulting in an actuarial 5-year relapse-free survival of 95%. No patients relapsed within the cranially reduced treatment volume above the top of T12. The cranial reduction of the para-aortic treatment fields resulted in a median reduction of treatment volume of 16% (range, 13-21%). The achieved median reduction in treatment volume of 16% appears to be relevant and is not associated with an increased relapse rate. This approach is recommended in analogy to the surgical approach in NSGCT to further minimize the risk of radiation-related late effects.
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Affiliation(s)
- Frank Bruns
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany.
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35
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Abstract
Postorchidectomy management of stage I testis seminoma has evolved for many years. Three treatment options should be discussed after surgery. Surveillance tends toward taking a more significant place to avoid overtreatment, adjuvant chemotherapy with carboplatin has demonstrated its efficiency, and for some, preventive radiotherapy, the historical reference treatment, is losing momentum. Whatever the chosen orientation, long-term prognosis is excellent with overall survival closed to 100%. In this context, this review underlines the advantages and the drawbacks of the three attitudes but also the unknowns relative to each. Indeed, their knowledge is crucial for informing clearly and with an objective way. Without gold-standard, but with three therapeutic options available, informing our patients is the key so they make an informed choice in dialogue with the oncologist.
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Affiliation(s)
- D Pouessel
- CRLC Val d'Aurelle-Paul-Lamarque, département d'oncologie médicale et d'oncologie radiothérapie, 298, rue des Apothicaires, 34298 Montpellier cedex 5, France
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Mottet N, Rousmans S, Culine S. [Systematic review 2007: Primary treatments of testicular germ cell tumors after radical orchydectomy]. Bull Cancer 2008; 95:205-234. [PMID: 18330045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The "Standards, Options and Recommendations" (SOR)program in oncology, has been initiated in 1993 by the Federation of French Cancer Centres and is realised in collaboration with public and private clinicians,professional federations, scientific societies and since 2005 with National cancer institute. Its aims are to develop clinical practice guidelines (CPG), health technologic assessment reports and systematic reviews. By preparing the latter, it provides support to the scientific societies for the update of their CPG. In this context, the SOR, in collaboration with the French Association of Urology (AFU), has developed a systematic review on the management of nonseminomatous (NSTGC) or seminomatous(STGC) testicular germ cell cancer treated with primary radiotherapy (RT), chemotherapy (CT) or surveillance (SV) after radical orchidectomy. Today, 80 % of patients with testicular germ cell cancer, including metastatic stage, can be cured. Actual challenges are to limit morbidity and late sequels of treatments while maintaining their therapeutic efficacy. Following this goal, surveillance, considered as a therapeutic option, is being broadly developed particularly for localised tumours. OBJECTIVE To synthesize outcomes of patients with NSTGC or STGC treated with primary RT, CT or SV after radical orchidectomy. SEARCH STRATEGY A systematic literature search has been performed on Medline between 01/2004 and 08/2007 and completed by the consultation of evidence based medicine websites, experts citations and further relevant references identified from trials revealed by electronic searches. SELECTION CRITERIA Randomised controlled trial (RCT), systematic reviews, and observational studies (prospective or retrospective cohorts) in patients with locally or advanced NSTGC or STGC treated with primary RT, CT or SV after radical orchidectomy have been included. DATA ANALYSIS Studies have been assessed for eligibility and quality by three independent reviewers. Authors were contacted to provide details of outstanding clinical trials. No quantitative analysis was initially planned because of the heterogeneity of experimental designs researched BIBLIOGRAPHICAL RESULTS: Twenty-nine trials have been included : 1 meta-analysis, 1 pooled analysis of 2 RCT, 4 non-inferiority RCT, 6 comparative studies (1 prospective, 5 retrospective) and 17 observational studies (7 prospective, 10 retrospective). Nineteen references were for NSTGC and 10 for STGC. CONCLUSIONS The choice of risk-adapted treatment for patients with locally NSTGC of the testis seems to be appropriate: SV for low risk patients and CT for others. For advanced stage, the suppression of bleomycine remains questionable. For local STGC, the choice of SV or CT versus RT needs to be confirmed by RCT with prolonged follow-up according to promising results in term of toxicity obtained with carboplatine or lower irradiation dose (20 Gy instead of 30 Gy). Finally, for advanced STGC, the utility of carboplatine single agent treatment versus cisplatin-based combination chemotherapy has not been proved.
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Affiliation(s)
- Nicolas Mottet
- Urologue, Clinique chirurgicale mutualiste, Saint-Etienne, France
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Segawa N, Hamada S, Takahara K, Tanaka K, Daimon M, Kanehara H, Suzuki T, Iwamoto Y, Tsuji M, Azuma H, Okuda J, Katsumata T, Katsuoka Y. [Ureteral-abdominal aortic fistula during the exchange of ureteral stenting: a case report]. Hinyokika Kiyo 2007; 53:565-9. [PMID: 17874549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We report a case of a patient with a fistula between the left ureter and abdominal aorta. The patient was a 44-year-old male who had undergone radiation therapy (intraoperative: 25 Gy, external beam: 50 Gy) and chemotherapy (CDDP: 250 mg) for retroperitoneal lymph node metastasis from seminoma. His postoperative course was complicated by stenosis of bilateral ureters, which were treated by indwelling double J-stents. Fifteen years after the operation, gross hematuria occurred from the left ureteral orifice when exchanging the left ureteral double J-stent. Computed tomographic scan demonstrated left ureteral-abdominal aortic fistula formation at the crossing point. Massive hemorrhage was suspected to have prompt fistula formation between the left ureter and the aorta. At exploration, there was a fistula of about 7 mm in diameter at the anterior surface of the aorta, and the stent was presumably inserted from it. The aortic fistula was successfully closed. In addition, the left ureter was ligated proximal to the fistula and percutaneous left nephrostomy were performed. His postoperative course was uneventful. We should be aware that uretero-arterial fistula can occur as a serious complication of ureteral catheter exchange after prolonged ureteral stenting and radiation therapy.
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Zhou JF, Bai CM, Yang D, Chen SC. [Clinical analysis of primary mediastinal germ cell tumors]. Zhonghua Zhong Liu Za Zhi 2007; 29:531-534. [PMID: 18069635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate the clinical and pathological features, optimal treatment and prognostic factor in primary mediastinal germ cell tumors (PMGCT). METHODS The clinical presentation, pathological features and therapeutic results of 29 patients with PMGCT were retrospectively analyzed. RESULTS All the 29 patients were male with a mean age of 26.1 +/- 9.6 years at diagnosis. All tumors were originated from the anterior mediastinum with a mean diameter of 16.0 +/- 5.2 cm. There were 5 (17.2%) primary mediastinal seminomas (PMSGCT) and 24 (82.8%) primary mediastinal nonseminomas (PMNSGCT) in this series. Dyspnea, cough and chest pain were the most common symptoms. Multimodality treatment consisting of cisplatin-based chemotherapy, surgery and radiotherapy was the principal therapy for PMGCT patients. The median survival of the 24 PMNSGCT patients was 19.0 months with 1-, 2-year survival rate of 65.3% and 28.1%, respectively; whereas the median survival of the 5 PMSGCT patients has not reached but longer with significant differences (P = 0.008). Cox multivariate analysis indicated that limited mediastinal disease at diagnosis (P = 0.004) and the use of cisplatin-based combined chemotherapy (P = 0.005) were independent good prognostic factors of PMNSGCT. CONCLUSION Primary mediastinal nonseminoma constitutes the most of primary mediastinal germ cell tumors. Cisplatin-based combined chemotherapy may be the most effective for the treatment of primary mediastinal germ cell tumors. The prognosis of primary mediastinal nonseminomas is significantly worse than that of primary mediastinal seminomas, and correlated with the extent of disease and chemotherapy.
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Affiliation(s)
- Jian-feng Zhou
- Department of Oncology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
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Mathis S, Dumas P, Neau JP, Gil R. La neuropathie motrice pure, une complication rare de la radiothérapie: trois observations et une revue de la littérature. Rev Med Interne 2007; 28:377-87. [PMID: 17337314 DOI: 10.1016/j.revmed.2007.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Revised: 01/22/2007] [Accepted: 01/31/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Early or late neurological symptoms with lesions of peripheral or central nervous system can originated from radiotherapy. METHODS We report three cases of pure motor neuropathy in patients, which were treated by X-ray treatment several years ago. RESULTS Three patients (35-65 years old) have been presenting a pure motor neuropathy between 8.5 and 21 years after radiotherapy for Hodgkin disease (two cases) or testicular seminoma (one case). In each case, a proximodistal weakness with proximal predominance was observed and confirmed by the electromyographic findings. After a gradual worsening, we observed a clinical stability in patients treated by anticoagulant (one case) or pentoxifylline (two cases). CONCLUSION Pure motor neuropathy is a rare and late complication of the radiotherapy. A treatment with anticoagulant or pentoxifylline, with or without tocopherol, has been suggested.
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Affiliation(s)
- S Mathis
- Clinique Neurologique, CHU de Poitiers, Université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex 05, France.
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Loriot Y, Fizazi K. [Management of clinical stage I testicular germ cell tumours]. Bull Cancer 2007; 94:439-48. [PMID: 17535781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 03/13/2007] [Indexed: 05/15/2023]
Abstract
Testicular germ-cell cancer is the most frequent malignancy in young men. In 80% of case no metastasis is observed at diagnosis. Orchidectomy is the initial therapeutic intervention. In case of a pure seminoma, three treatment options should be discussed after surgery : radiotherapy with a limited dose and volume, surveillance, and chemotherapy by single-agent carboplatin. In non-seminomatous germ cell tumour three options should also be considered : surveillance, chemotherapy (two cycles of the BEP regimen) or retroperitoneal lymph node dissection. The strategy should be chosen taking into account predictive factors of relapse and the patient willing. Whatever the strategy, the cure rate is about 99%.
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Affiliation(s)
- Yohann Loriot
- Institut Gustave Roussy, 39 rue Camille-Desmoulins, 94800 Villejuif.
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Abstract
PURPOSE To report on long-term outcomes among patients with stage I seminoma treated by orchiectomy with or without adjuvant radiation. MATERIALS AND METHODS A retrospective review of medical records of patients treated between 1974 and 2002 was undertaken to identify factors associated with patient outcomes. RESULTS With a median follow-up of 7.7 years, 80% (4 of 5) of the surveillance group experienced a disease relapse, while only 3% (2 of 70) in the radiation therapy group had disease relapse. This difference in relapse rates was statistically significant, but there was no significant difference in overall survival between the 2 groups. There was a significant relationship between patient age and disease relapse, whereby all of the relapses were seen in patients younger than 36 years at diagnosis (P = 0.03). Of the total 75 patients, 7 (9%) developed second primary tumors. Six of them (6 of 7) were treated with adjuvant radiation, and 1 patient (1 of 7) was on surveillance. CONCLUSION In this study, risk of relapse was significantly associated with surveillance and in patients younger than 36 years at diagnosis. These results suggest that surveillance can only be safely adopted for patients who can be followed up closely. We consider adjuvant radiation a very effective choice despite the low risk of associated secondary malignancies.
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Affiliation(s)
- Gary Y Yang
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
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Loriot Y, Fizazi K. [Management of localized germ-cell tumours of the testis]. Rev Prat 2007; 57:379-84. [PMID: 17455739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Stage 1 is currently the most frequent pattern at diagnosis of germ-cell tumours. Prognosis is excellent and different options are available after orchidectomy. The therapeutic choice should be taken after fair and extensive information regarding the limitations of each option therefore taking into account both predictive factors of relapse and patient individual willing. In case of pure seminoma, prophylactic radiotherapy directed to the retroperitoneal lymph nodes, chemotherapy by single-agent carboplatin and surveillance with differed treatment at relapse are the three currently available attitudes. In non-seminomatous germ cell tumours three options should also be considered: surveillance (watchful waiting), chemotherapy by two cycles of BEP, or retroperitoneal lymph node dissection.
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Affiliation(s)
- Yohann Loriot
- Département de médecine, institut Gustave-Roussy, Villejuif Cedex
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Mulla MG, Ananthkrishnan G, Mirza MS, Bungay P, Puri S, Chakraborti P. Renal artery stenosis after radiotherapy for stage I seminoma, a case report. Clin Oncol (R Coll Radiol) 2007; 19:209. [PMID: 17359909 DOI: 10.1016/j.clon.2007.01.114] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 01/15/2007] [Indexed: 11/30/2022]
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Neal RD, Stuart N, Wilkinson C. Testicular cancer: seminoma. BMJ Clin Evid 2007; 2007:1807. [PMID: 19454048 PMCID: PMC2943781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 25-35 years. About half of testicular cancers are seminomas, which tend to affect older men and have a good prognosis. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in men with stage 1 seminoma (confined to testis) who have undergone orchidectomy? What are the effects of treatments in men with good-prognosis non-stage 1 seminoma who have undergone orchidectomy? What are the effects of maintenance chemotherapy in men in remission after orchidectomy and chemotherapy for good-prognosis non-stage 1 seminoma? What are the effects of treatments in men with intermediate-prognosis seminoma who have undergone orchidectomy? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant irradiation (20 Gy in 10 fractions to paraaortic area, 30 Gy in 15 fractions to paraaortic area and iliac nodes), chemotherapy (maintenance, adjuvant, single-agent carboplatin, three or four cycles, different number of cycles of adjuvant, using bleomycin added to vinblastine plus cisplatin, using etoposide plus cisplatin with or without bleomycin, adding higher doses to a two-drug chemotherapy regimen using cisplatin or vinblastine), radiotherapy (adjuvant, different drug combinations, 30-36 Gy in 15-18 fractions), surveillance.
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Affiliation(s)
- Richard David Neal
- North Wales Clinical School, Cardiff University Wales College of Medicine, Wrexham, Wales
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Brydøy M, Storstein A, Dahl O. Transient neurological adverse effects following low dose radiation therapy for early stage testicular seminoma. Radiother Oncol 2007; 82:137-44. [PMID: 17189656 DOI: 10.1016/j.radonc.2006.11.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 11/28/2006] [Accepted: 11/30/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to estimate the rate of neurological adverse effects following radiotherapy for testicular seminoma and to disclose possible dose-related effects. PATIENTS AND METHODS All seminoma patients (n=346) treated 1980-2001 at our department with radiotherapy as the only treatment modality following orchiectomy constitute the study group (median follow-up 10 years). Since 1980, clinical data including possible side effects have systematically been recorded in these patients. These records were used to identify men with possible neurological adverse effects. Univariate logistic regression was used to estimate dose-related effects. RESULTS Overall, 11 men (3.2%) with neurological symptoms probably related to radiotherapy were identified. Seven men treated with 25.2-36 Gray presented with sensory symptoms about 2 months following radiotherapy. These symptoms resolved in all but one after 1-3 months. The remaining four men (dose 36-40 Gray) had motor impairment which lasted at least one year, but none had persistent pareses at long-term follow-up. There was a statistically significant (p=0.02) increase in rate of motor symptoms with higher dose. CONCLUSIONS Although motor impairment is unlikely to occur at current standard doses for seminomas, physicians should be ware of the sensory symptoms these men may exhibit.
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Affiliation(s)
- Marianne Brydøy
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.
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Abid L, Ayadi-Kaddour A, Braham E, Smati B, Ismail O, Kilani T, El Mezni F. [Primary mediastinal seminoma. Report of three cases]. Tunis Med 2007; 85:74-7. [PMID: 17424717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Primary mediastinal seminomas (PMS) are rare tumors that are morphologically similar to their testicular counterparts but may have different biologic behavior due to their particular anatomical location. AIM New cases report of PMS CASES: Three new cases of primary mediastinal seminoma are presented. The patients were men aged of 16, 33 and 47 years. Their clinical symptoms included cough, dyspnea, chest pain and superior vena cava syndrome. None of the patients had a previous history of testicular neoplasm or tumor elsewhere. Mediastinoscopic biopsy was performed and histological examination results revealed a seminoma. Immunohistochemical showed membranous staining with placental alkaline phosphatase in the three cases. Chemotherapy has largely replaced surgical resection and radiotherapy as the initial treatment in patients with mediastinal seminoma.
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Affiliation(s)
- Leïla Abid
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital Abderrahman-Mami - 2080 Ariana
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Tovar Rodríguez JM, Bañuelos Avila L, Chávez Zúñiga I, García Rodríguez F, Vargas Hernández VM. [Fertility and testicular function in a patient with germ cell extragonadal tumor. A report of a case]. Ginecol Obstet Mex 2007; 75:46-9. [PMID: 17542269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Males are affected from primary extragonadal germ cell tumors with a frequency of 2 to 5%. There is a high incidence of infertility of more than 60% and most of the cases have azoospermia due to testicular damage. The hormonal profile of these patients shows normal luteinizing hormone, normal follicle stimulating hormone and normal testosterone and estradiol. We communicate the case of a male who had a primary retroperitoneal germ cell tumor with a low title of chorionic gonadotropin, elevated estradiol and normal testosterone, prolactin and seminogram. Before beginning treatment with chemotherapy, his wife became pregnant delivering twins, both males. The patient was treated with chemo and radiotherapy after which he became azoospermic with an increase in both luteinizing hormone and follicle stimulating, decreased levels of estradiol and without alteration in prolactin and testosterone. The pituitary testicle axis was affected by the tumor, but the microenvironment of the testicles did not seem to be damaged only after initiating treatment.
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Affiliation(s)
- José Maria Tovar Rodríguez
- Laboratorio de Biología de la Reproducción, Hospital Juárez de México, Secretaría de Salud, colonia Magdalena de las Salinas, DF México.
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Niewald M, Freyd J, Fleckenstein J, Wullich B, Rübe C. Low-dose radiotherapy for Stage I seminoma—long-term results. Int J Radiat Oncol Biol Phys 2006; 66:1112-9. [PMID: 16979844 DOI: 10.1016/j.ijrobp.2006.06.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/25/2006] [Accepted: 06/27/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to review retrospectively the results of low-dose radiotherapy for Stage I seminoma using four different fractionation schedules and target volume definitions. METHODS AND MATERIALS A total of 191 patients underwent irradiation for histologically proven Stage I seminoma after undergoing an inguinal orchiectomy. Fractionation schedules were used one after another as follows: Total dose 30 Gy (dose/fraction 1.5 Gy, 16 patients), total dose 25.5 Gy (dose/fraction 1.5 Gy, 62 patients), total dose 20 Gy (dose/fraction 2 Gy, 69 patients), total dose 26 Gy (dose/fraction 2 Gy, 29 patients). The remaining 12 patients were excluded from this study. In the same period the target volume was gradually reduced. In 1983 the paraaortic, pelvic and inguinal regions were irradiated; later the target volume was reduced to the paraaortic region exclusively. RESULTS Overall survival and event-free survival were identical in all groups ranging from 95% to 100% /5 years. Three patients experienced a lymph node metastasis during follow-up, 3 patients a distant metastasis to the lung and the bones. Mild acute side effects were noted in 8% to 15% of the patients, and very mild long-term side effects in 1% to 5% of patients. Multivariate analysis showed no prognostic significance of total dose, dose per fraction, or target volume. In univariate analysis, a higher frequency of acute side effects to the skin and the bowel was related to a higher total dose, and an elevated frequency of nausea was related to a higher daily dose per fraction. CONCLUSION Using lower doses and limiting the target volume to the paraaortic region exclusively did not result in a worse prognosis in our patient series.
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Affiliation(s)
- Marcus Niewald
- Department of Radiooncology, Saarland University Hospital, Homburg, Germany.
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Abstract
Testicular cancer is the most common solid tumour in young men, and the treatment of testicular germ cell tumours (TGCT) has been called a success story of medical oncology, germ cell cancer being regarded as the "model of a curable neoplasm". Even with metastatic disease, high cure rates can be achieved: the overall 5-year survival for all stages of TGCT is approximately 80%. Today, elaborate systems for prognostic evaluation for gonadal and extragonadal germ cell tumours facilitate the choice of the most appropriate therapy for individual patients. In doing so, the ultimate goal of treatment is tumour-free survival for any patient with TGCT. This goal has already been reached for >99% of the patients with early-stage tumours, as well as for the majority of patients with advanced disease (56% of patients with metastases are considered to have a good prognosis at the time of diagnosis; the 5-year survival rate for this group is 90%). However, patients with 'intermediate' or 'poor' prognosis at the time of diagnosis, as well as patients with relapsed disease after cisplatin-containing therapy, still have an unsatisfactorily low 5-year survival rate after standard therapy with PEB (cisplatin, etoposide, bleomycin) of only 80%, 45-55% and 20-25%, respectively.Therefore, our goals must be (i) to limit acute and chronic toxicity by avoiding overtreatment for patients with localised disease and/or good prognosis with advanced disease; and (ii) to identify patients with poor prognosis and treat them in specialised centres, where not only is optimal interdisciplinary care available but new treatment strategies are being applied. For example, tandem high-dose chemotherapy regimens might be effective in achieving higher cure rates in these patients.
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Affiliation(s)
- Hans-Georg Kopp
- Department of Medical Oncology, Medical Center II, Hematology, Rheumatology, Pneumology and Immunology, South West German Cancer Center, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
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Jin BF, Yang XY, Liu JY, Huang YF, Wang XL, Xu FS. [Integrated treatment for azoospermia caused by radiotherapy after surgical treatment of spermatocytoma: a case report]. Zhonghua Nan Ke Xue 2006; 12:836-8. [PMID: 17009540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To investigate a therapeutic method for male infertility caused by radiotherapy after surgical treatment of spermatocytoma. METHODS A case of azoospermia caused by radiotherapy after surgical treatment of spermatocytoma was reported and the Chinese medicine Jiaweishuiluerxiandan was used as a major therapy for 3 years. RESULTS The patient's health condition was improved dramatically two years after being treated by the Chinese medicine but no sperm was found in his semen. However, three years after the treatment, his spermatozoon density was recovered from zero to 2.0 x 10(6)/ml with normal morphology. His sperm was subsequently used for intracytoplasmic sperm injection, which made his spouse pregnant successfully, and an healthy male infant was born by caesarean birth. CONCLUSION Chinese medicine is a successful try at treating male infertility caused by radiotherapy after surgical treatment of spermatocytoma. For those who have failed to get their sperm frozen before surgery, Chinese medicine is a choice for remediation.
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Affiliation(s)
- Bao-fang Jin
- Department of Andrology, Nanjing General Hospital of Nanjing Command, Nanjing, Jiangsu 210002, China.
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