Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience.

Gels, M. E.; Hoekstra, HJ; Sleijfer, Dirk; Marrink, J; Bruijn, H W de; Molenaar, Willemina M.; Freling, Nicole; Droste, J. H. J.; Koops, H. Schraffordt

doi:10.1200/jco.1995.13.5.1188

Cited by 141 publications

(87 citation statements)

References 34 publications

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“…Approximately 15-30% of patients with stage I NSGCT will relapse with intrathoracic disease [8][9][10][11]. Our series is entirely in keeping with this, with a relapse rate of 19%.…”

Section: Discussionsupporting

confidence: 70%

“…Conversely, the risk of not monitoring the chest is that large asymptomatic pulmonary metastases may occur, thereby potentially worsening prognosis and complicating subsequent treatment [16]. In comparison to CT, chest X-ray is generally not considered to be a sensitive method of detecting small pulmonary nodules [11,17]. However, plain chest X-ray can detect pulmonary nodules as small as 5 mm in size depending on location.…”

Section: Discussionmentioning

confidence: 99%

“…Gels et al [11] evaluated data from 154 patients with stage I non-seminomatous testicular germ-cell cancer on surveillance. Patients underwent regular surveillance thoracic CT scanning and as such they concluded that chest X-ray could be omitted from their surveillance policy.…”

Section: Discussionmentioning

confidence: 99%

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Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?

et al. 2002

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Background:The standard management approach to stage I testicular non-seminomatous germ-cell tumours (NSGCT) in the UK is a surveillance programme with adjuvant bleomycin, etoposide, cisplatin (BEP) chemotherapy being offered to individuals with high risk disease. Conventionally, computed tomography (CT) scanning of the thorax has formed part of the surveillance programme. This paper evaluates the contribution of routine thoracic CT imaging in the management of this disease. Patients and methods:We retrospectively reviewed the case notes of 168 patients with stage I NSGCT referred to the Wessex Medical Oncology Unit over a period of 13 years (1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998). These patients entered onto a surveillance programme that included serial chest X-ray follow up rather than thoracic CT.Results: Forty-two out of 168 patients (25%) evaluated suffered relapse during the follow up period.Eight of 42 patients (19%) relapsed with intrathoracic disease. Seven out of eight of these patients (87.5%) had at least one other indicator of disease recurrence (elevated serum marker, abnormal abdominal CT). One of 42 patients (2.4%) relapsed with isolated intrathoracic disease with no other indicator of relapse. All patients with intrathoracic relapse had evidence of disease on chest X-ray. Of the 42 relapsing patients, 93% could be categorised as having good prognosis metastatic disease. Seven per cent relapsed with intermediate or poor prognostic disease; relapse in these patients would not have been detected earlier with the inclusion of routine thoracic CT. Only one patient has died giving a cure rate of 98% for relapsing patients. Conclusions:The elimination of chest CT did not compromise outcome but significantly reduced radiation exposure thereby minimising the risk of radiation-induced secondary malignancy. Continued review of surveillance programmes is essential if we are to optimise management of this disease.

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“…Approximately 15-30% of patients with stage I NSGCT will relapse with intrathoracic disease [8][9][10][11]. Our series is entirely in keeping with this, with a relapse rate of 19%.…”

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?

et al. 2002

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“…The survival outcomes are summarized in Table 5. 13,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63] The presence of microscopic vascular or lymphatic invasion in the primary tumour is the most important factor predicting relapse and the presence or absence of this factor has been used to divide patients: those with high-risk disease (a third of the cases) who have about a 50% risk of relapse, and those with low-risk disease who have about a 15% to 20% risk of relapse. 45 …”

Section: E25mentioning

confidence: 99%

Canadian consensus guidelines for the management of testicular germ cell cancer

Wood

Kollmannsberger

Jewett

et al. 2013

CUAJ

123

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“…Subsequent studies have shown that vascular invasion (VI) is the single most important prognostic factor regarding risk of relapse [14][15][16][17]. Without adjuvant treatment, the high-risk group (VI positive) has a 3-year relapse rate of approximately 50%, while low-risk patients (VI negative) have a relapse risk of 10 to 20% [1,3,[16][17][18][19][20][21][22].…”

Section: Prognostic Risk Factorsmentioning

confidence: 99%

Current Concepts in Management of Stage I NSGCT

Ahluwalia

Gautam

2016

Indian J Surg Oncol

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While about 50% of non-seminomatous germ cell tumors of the testes present as clinical stage I (CSI), further management of these patients continues to be mired in controversy. Active surveillance is a frontline option for low-risk CS I patients and according to some, even the high-risk ones with high embryonal carcinoma (ECA) component and vascular invasion (VI). However, it carries the disadvantage of long-term surveillance, the need for prolonged chemotherapy in case of recurrence and the possibility of secondary malignancies due to radiation exposure from frequent CT scans. One or two cycles of BEP chemotherapy is a popular alternative to active surveillance which carries a very low relapse rate, but valid concerns about overtreatment of a majority of patients, with the attendant chemotherapy-related toxicity exist. Retroperitoneal lymph node dissection has been used as a means of avoiding chemotherapy, especially in high-risk patients, but carries the disadvantage of a high surgical morbidity and complications. As with any major surgical procedure, the best results are dependent on the experience and skill of the individual surgeon.

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Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience.

Cited by 141 publications

References 34 publications

Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?

Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?

Canadian consensus guidelines for the management of testicular germ cell cancer

Current Concepts in Management of Stage I NSGCT

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