Evidence‐based guidelines for following stage 1 seminoma

Abstract

A chemically crosslinked biodegradable hydrogel was prepared via a macromer technique, and physicochemical characterizations associated with its potential application as an injectable biomaterial were carried out. The macromers were composed of poly(ethylene glycol) extended with oligomers of biodegradable polyesters such as oligolactide and end‐capped with acryloyl groups. Hydrogels were obtained through the polymerization of the macromer aqueous solutions in phosphate‐buffered saline initiated by a redox initiator system at body temperature. The initiator system was composed of ammonium persulfate as an initiator and N,N,N′,N′‐tetramethylethylene diamine as an accelerator. The modulus of this chemical gel was much higher than that of a Pluronic physical gel. In vitro biodegradation was also confirmed. The degradation rates were highly tunable by the adjustment of several factors, such as the kind of ester group, the block length of the oligoester, and even the concentration of the accelerator used in the crosslinking reaction. The gelation time could be adjusted to meet the requirements of an injectable biomaterial. The effect of the polymerization heat seemed not to be significant. This kind of biodegradable hydrogel might be in situ formed after being injected into the body and shows potential applications as a unique tissue engineering material free of porogening techniques in scaffold fabrication and less invasive in implantation. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci, 2006

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

“…The trial has only reported 4-year follow-up data and although there are limited data on risk of late relapse and on long-term toxicity, in many UK centres the use of carboplatin for stage I seminoma now exceeds the use of radiotherapy. Five-year relapse rates for a single cycle of carboplatin are 6.1% with more than 80% of relapses occurring in the abdomen (Martin et al, 2007) (in contrast to patients treated with para-aortic radiotherapy where abdominal relapses are extremely uncommon). We, therefore, recommend CT scan of the abdomen and a chest X-ray yearly, for the first 2 years and again at 5 years; the pelvis should only be scanned if there has been scrotal interference or previous pelvic surgery [III, B].…”

“…The chest can be imaged both by chest X-ray and CT of the chest but thoracic relapse in nonseminomatous (NS) will for the most part be marker positive, and the great majority of GCTs that relapse will have significant disease burden outside the chest (Gietema et al, 2002;Oldenburg et al, 2006;Martin et al, 2007). Computerised tomography chest may pick up small marker-negative lesions not visible on chest X-ray, but unless the detection of such small lesions is likely to have prognostic significance, we omit chest CT from our follow-up schedules due to the significant additional radiation exposure.…”

“…Relapses in the treatment field are extremely uncommon; however, when the pelvic field is omitted, there is a small but statistically higher rate of pelvic relapse (Fossa et al, 1999a). In a combined review of 1535 patients treated with para-aortic radiotherapy, the relapse rate at 5 years was 3.6%, with 0.3% of relapses occurring in the abdomen (Martin et al, 2007). Most relapses occur in the first 2 years.…”

“…Most relapses occur in the first 2 years. The annual hazard ratio from the largest reported series for relapse between 2 to 6 years is 0.25 -1% (Martin et al, 2007). For patients treated with para-aortic radiotherapy, we suggest 3 monthly clinical examination and markers for the first year and 4 monthly for the second year, and then 6 monthly until 5 years [III, B].…”

Side Effects of Adjuvant Radiotherapy in Men with Testicular Seminoma Stage I

“…Advances in radiotherapy and chemotherapy with similar results may in near future provide an answer as to which therapy option is less toxic (30). Radiotherapy has been the accepted cancer therapy option for at least fi ve decades.…”