High-risk clinical stage I nonseminomatous germ cell tumors: the case for chemotherapy

Westermann, D.; Studer, Urs E.

doi:10.1007/s00345-009-0456-3

Cited by 17 publications

(9 citation statements)

References 49 publications

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“…We did not use the policy with one cycle of BEP chemotherapy, so we cannot assess the outcome. Given the two cycles of BEP, only 3% of patients relapsed; therefore, the risk reduction of relapse is 90% [25]. In our present risk-adapted study we observed 2/155 (1.3 %) relapses in the group of patients with vascular invasion after adjuvant chemotherapy (two cycles of BEP regimen).…”

Section: Discussionmentioning

confidence: 41%

“…Albers et al [24] reported results of the largest randomized trial (German Testicular Cancer Study Group) investigating adjuvant treatment strategies in CSI NSGCTT which showed 2/174 (1.2%) relapses following one course of BEP chemotherapy. A pooled analysis of 13 studies involving 1043 patients revealed a relapse rate of 1.6% in 6 patients (0.6%) dying of disease [25]. We did not use the policy with one cycle of BEP chemotherapy, so we cannot assess the outcome.…”

Section: Discussionmentioning

confidence: 99%

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Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

Ondruš¹,

Ondrušová²,

Kajo³

2015

neo

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Surveillance after orchiectomy alone has become popular in the management of clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Efforts to identify patients at high risk of disease progression led to a search for risk factors in CSI NSGCTT. The aim of the present study was to analyse single-centre experience with risk-adapted therapeutic approaches (active surveillance versus adjuvant chemotherapy). From 1/1992 to 12/2013 a total of 431 CSI NSGCTT patients were included in the study and stratified into two groups according to risk-adapted therapeutic approaches. Group A (low-risk CSI NSGCTT) consisted of 276 patients who underwent active surveillance, progression of disease occurred in 46 (16.7%) patients with a median follow-up of 7.2 months. Six patients (2.2 %) of this group died with a median follow-up of 34.3 months. Group B (high-risk CSI NSGCTT) consisted of 155 patients who were treated with adjuvant chemotherapy, disease progression occurred in two (1.3 %) of them with a median follow-up of 56.2 months. One patient (0.6 %) died 139.4 months following orchiectomy. Overall survival rate of all CSI NSGCTT patients in both groups was 424/431 (98.4 %) with median follow-up of 130.4 months following orchiectomy. Surveillance policy is recommended only in patients with low-risk CSI NSGCTT. Key words: testicular cancer, surveillance, adjuvant chemotherapy, disease progressionThe introduction of cisplatin-based combination chemotherapy has revolutionized the treatment of metastatic testicular cancer [1]. Considering the high success rate in the salvage of disseminated cancer, it seemed reasonable to propose patients with orchiectomy alone followed by surveillance only [2] for managing clinical stage I nonseminomatous germ cell testicular tumors (CSI NSGCTT). Patients who relapse are treated with systemic chemotherapy, whereas those who do not relapse are spared unnecessary treatment.The surveillance after orchiectomy alone has gained a lot of popularity in the management of CSI NSGCTT. Preliminary results were enthusiastic [2,3,4], but critical voices arose against general use of this option as a routine management [5]. With longer observation, the relapse rate increased up to 25 % or more after orchiectomy [6,7]. Several studies [5,7,8,9] identified statistically significant predictors of relapse in CSI NSGCTT patients who might therefore benefit from a program other than surveillance. Vascular invasion of the primary tumor was the most consistent prognostic feature identified. Predominantly embryonal carcinoma histology and T2-4 stage were also frequently associated with rate of relapse. The results of our previous reports [6,10,11,12,13] indicate, that prognostic factors useful for stratification of CSI NSGCTT patients to different therapeutic approaches may be established. There have been identified risk factors which define a low risk and a high risk group of patients and which have led to a riskadapted approach of treatment favoring surveillance for patients with low risk and chemot...

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

Ondruš¹,

Ondrušová²,

Kajo³

2015

neo

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“…compared to the normal population after BEP administration (26). Although Chamie et al (27) reported higher risk of secondary solid malignancy due to CT some studies report a 0.5-1% risk of hematological malignancy as a result of high-dose etoposide (28). The adverse effect of cisplatin-based CT on fertility and sexual function is not yet known (29).…”

Section: Discussionmentioning

confidence: 99%

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

Aydın¹,

Bolat²,

Taşlı³

et al. 2018

uob

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IntroductionTesticular cancer accounts for 1-1.5% of all cancers in men and 5% of male urological malignancies. It is usually seen between the ages of 15 and 35. In the USA, it is the most common malignancy among men aged 20-40 years and the second most common malignancy after leukemia among adolescents aged 15-19 years. The prevalence of bilateral germ cell tumor (GCT) is 2.5%, with 0.6% of these being synchronous tumors and 1.9% being metachronous contralateral tumors (1).The vast majority (90-95%) of testicular tumors are GCTs. The most common histological type of GCT is seminoma (55%), which peaks between the ages of 30-40 years. Non-seminomas account for 40% and peak between the ages of 20-30 years (2). Stage 1 seminomas comprise the majority (80-85%) of GCTs diagnosed in daily practice (3,4). The 10-year overall Objective: Treatment modalities applied after orchiectomy in early-stage germ cell tumors (GCTs) include significant changes in each new study. In this study we reevaluated the treatment approaches used in our hospital between 2010-2014 according to current guidelines. Materials and Methods: We retrospectively evaluated the oncologic treatments and follow-up data of 32 patients who underwent radical orchiectomy between January 2010 and December 2014 due to testicular tumor and were diagnosed with early stage GCT in the Urology Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of University of Health Sciences. Results: Of 19 patients diagnosed with stage 1 seminomas, 3 patients in the low risk group were followed. Of 4 patients who received single-dose carboplatin therapy, 2 were at low risk and 2 were at high risk. Therefore, 2 patients at low-risk had overtreatment. Twelve patients were treated with radiotherapy (RT) that was no longer recommended in guidelines after 2014. Two patients in the low risk group of stage 1 non-seminoma were followed. One of them had recurrence at 12 months, and received 3 cycles of bleomycin + etoposide + cisplatin (BEP) according to current guidelines. Four patients with stage 1 non-seminoma underwent 2 cycles of BEP because they were considered at high risk. These patients are now recommended to receive 1 cycle BEP according to the current guidelines. While 4 patients with stage 1 mixed GCT were followed because of low risk, one patient was administered 2 cycle of BEP based on the old guidelines, at that time because of high risk. In the seminoma group that was administered RT, acute myeloblastic leukemia and oligospermia toxicity were detected, but these were not observed in the carboplatin group. One of high-risk non-seminoma patients who received 2 doses of BEP developed Myelodysplastic syndrome. Conclusion: Early-stage GCTs have high cancer-specific and overall survival rates with appropriate treatment approaches. Although there are still controversial issues regarding their management, treatment approaches are changing with each study. Therefore, it is crucial to remain informed about current international guidelines and...

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“…Administration of adjuvant chemotherapy after orchiectomy on CSI NSGCTT nearly eliminates the risk of relapse. A pooled analysis of 13 studies involving 1,043 patients revealed a relapse rate of 1.6% with six patients (0.6%) dying of disease [26]. Given the two cycles of BEP, only 3% of patients relapsed; therefore, the risk reduction of relapse is 90%.…”

Section: Discussionmentioning

confidence: 99%

Controversies in the Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

et al. 2015

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SummarySurveillance after orchiectomy alone has become popular in the management of clinical stage I of nonseminomatous germ cell testicular tumors (CSI NSGCTT). Eff orts to identify patients at high-risk of relapse led to a search for risk factors in CSI NSGCTT. The aim of the current study was to analyze long-term experiences with risk-adapted therapeutic approaches (active surveillance and adjuvant chemotherapy). From 1/ 1992 to 2/ 2015, a total of 454 CSI NSGCTT patients were included in the study and stratifi ed into two groups according to risk-adapted therapeutic approaches. In Group A (low-risk CSI NSGCTT), which consisted of 287 patients who underwent surveillance, relapse occurred in 48 (16.7%) patients with a median follow-up of 7.0 months. Six patients (2.1%) of this group died with a median follow-up of 34.3 months. In Group B (high-risk CSI NSGCTT), which consisted of 167 patients who were treated with adjuvant chemotherapy, relapse occurred in two (1.2%) patients with a median follow-up of 56.2 months. One patient (0.6%) died 139.4 months following orchiectomy. Statistically signifi cant diff erence in progression free survival between these two groups was found, but no signifi cant diff erence in overall survival. Key words testicular cancer -surveillance -adjuvant chemotherapy -disease progression SúhrnPrísny dohľad po orchiektómii samotnej sa stal populárnym v manažmente neseminomatóznych germinatívnych nádorov testis v I. klinickom štádiu (clinical stage I nonseminomatous germ cell testicular tumors -CSI NSGCTT). Úsilie identifi kovať pa cientov s vysokým rizikom progresie ochorenia viedlo k vyhľadávaniu rizikových faktorov u CSI NSGCTT. Cieľom súčasnej štúdie bolo analyzovať dlhoročné skúsenosti s liečebnými postupmi založenými na prítomnosti rizikových faktorov (prísny dohľad a adjuvantná chemoterapia). V období 1/ 1992-2/ 2015 bolo celkovo 454 pa cientov s CSI NSGCTT zaradených do štúdie. Stratifi kovali sa do dvoch skupín podľa použitých liečebných postupov v závislosti na prítomnosti rizikových faktorov. Skupina A (CSI NSGCTT s nízkym rizikom) pozostávala z 287 pa cientov ktorí podstúpili prísny dohľad, progresia ochorenia sa zistila u 48 (16,7 %) pa cientov po mediáne sledovania 7,0 mesiacov. Šesť pa cientov (2,1 %) v tejto skupine zomrelo po mediáne sledovania 34,3 mesiacov. Skupina B (CSI NSGCTT s vysokým rizikom) pozostávala z 167 pa cientov, ktorí boli dostávali adjuvantnú chemoterapiu, progresia ochorenia sa zistila u dvoch pa cientov (1,2 %) s mediánom sledovania 56,2 mesiacov. Jeden pa cient (0,6 %) zomrel 139,4 mesiacov po orchiektómii. Štatisticky významný rozdiel medzi oboma skupinami sa zistil v prežívaní bez progresie ochorenia, avšak nevýznamný bol rozdiel v celkovom prežívaní. Klúčové slová testikulárne nádory -prísny dohľad -adjuvantná chemoterapia -progresia ochoreniaThis publication is the result of the implementation of project APVV-0016-11 supported by the Slovak Research and Development Agency.Práca bola podporená grantom Agentúry pre podporu výskumu a vývoja APVV -00...

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High-risk clinical stage I nonseminomatous germ cell tumors: the case for chemotherapy

Cited by 17 publications

References 49 publications

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

Controversies in the Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

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High-risk clinical stage I nonseminomatous germ cell tumors: the case for chemotherapy

Cited by 17 publications

References 49 publications

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

Controversies in the Management of Clinical Stage I Nonseminomatous Germ Cell Testicular Cancer

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Product

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Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience

Management of patients with clinical stage I nonseminomatous germ cell testicular cancer: Active surveillance versus adjuvant chemotherapy – single-centre experience