Current urologic care for testicular germ cell tumors in pediatric and adolescent patients

Grantham, Erin C.; Caldwell, Burton V.; Cost, Nicholas G.

doi:10.1016/j.urolonc.2015.06.008

Cited by 30 publications

(31 citation statements)

References 75 publications

(94 reference statements)

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“…(12)(13) Meanwhile, for extremely long survival time of these pediatric patients, treatment-related toxicity also should be taken into consideration. (21) In some studies, primary chemotherapy was associated with an extremely low relapse rate, and it decreased relapse rate in the high-risk group signi cantly. (6) So we used decision analysis to develop a model to evaluate the chemotherapy exposure between two protocols.…”

Section: Discussionmentioning

confidence: 99%

Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

Chen

Bian

et al. 2020

Preprint

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Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children. Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility. Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.

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Section: Discussionmentioning

confidence: 99%

Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

Chen

Bian

et al. 2020

Preprint

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“…In their adult counterparts, risk-adapted management has favorable outcomes, and decision analysis has demonstrated that surveillance is the preferred intervention, except for those patients with a high risk of relapse [12,13]. Meanwhile, due to the extremely long survival time of these pediatric patients, treatment-related toxicity also should be taken into consideration [21]. In some studies, primary chemotherapy was associated with an extremely low relapse rate, and it decreased the relapse rate in the high-risk group significantly [6].…”

Section: Discussionmentioning

confidence: 99%

Risk-adapted treatment reduced chemotherapy exposure for clinical stage I pediatric testicular cancer

Chen

Bian

et al. 2020

BMC Med Inform Decis Mak

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Background Different from adult clinical stage I (CS1) testicular cancer, surveillance has been recommended for CS1 pediatric testicular cancer. However, among high-risk children, more than 50% suffer a relapse and progression during surveillance, and adjuvant chemotherapy needs to be administered. Risk-adapted treatment might reduce chemotherapy exposure among these children. Methods A decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as the relapse rates of different groups during surveillance or after chemotherapy were collected from the literature. A survey of urologists was conducted to evaluate the toxicity of first-line and second-line chemotherapy. Using the decision analysis model, chemotherapy exposure of the risk-adapted treatment and surveillance strategies were compared based on this series of clinical utilities. One-way and two-way tests were applied to check the feasibility. Results In the base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment resulted in a lower exposure to chemotherapy than surveillance (average: 0.7965 cycles verse 1.3419 cycles). The sensitivity analysis demonstrated that when the relapse rate after primary chemotherapy was ≤ 0.10 and the relapse rate of the high-risk group was ≥ 0.40, risk-adapted treatment would result in a lower exposure to chemotherapy, without any association with the proportion of low-risk patients, the relapse rate of the low-risk group, the relapse rate after salvage chemotherapy or the toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions Based on the decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients, and an evaluation after orchiectomy was critical to this process. Additional clinical studies are needed to validate this statement.

show abstract

“…(12)(13) Meanwhile, for extremely long survival time of these pediatric patients, treatmentrelated toxicity also should be taken into consideration. (21) In some studies, primary chemotherapy was associated with an extremely low relapse rate, and it decreased relapse rate in the high-risk group significantly. (6) So we used decision analysis to develop a model to evaluate the chemotherapy exposure between two protocols.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis

Zhang

et al. 2019

Preprint

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Current urologic care for testicular germ cell tumors in pediatric and adolescent patients

Cited by 30 publications

References 75 publications

Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

Risk-adapted treatment reduced chemotherapy exposure for clinical stage I pediatric testicular cancer

Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis

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