Interdisciplinary Evidence-Based Recommendations for the Follow-Up of Testicular Germ Cell Cancer Patients

Abstract

Over the last years, clear treatment recommendations for patients with testicular cancer have been published. This has led to significant improvements in outcome and survival. Moreover, active surveillance has become a cornerstone in the management of clinical stage I seminomatous and non-seminomatous germ cell tumors. On the other hand, the existing recommendations for the follow-up of testis cancer patients are unclear and differ widely. Follow-up recommendations in this young patient population have to be as evidence based as possible, feasible in order to ensure adherence, and must not be harmful. Therefore, attention has to be paid to the negative impact of unnecessary radiation exposure. Recently, new evidence became available regarding the relapse pattern of different disease stages of testicular cancer, the use of imaging at follow-up, and the risks of excessive radiation due to imaging, and in particular that of computed tomography (CT) scans. This article summarizes the recommendations for follow-up of testicular cancer patients of an interdisciplinary multinational working group consisting of urologists, medical oncologists, and radiation oncologists.

Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach

“…16 In our cohort of patients on surveillance, only 2 relapses (2%) were to supradiaphragmatic sites, and both were associated with either para-aortic or inguinal nodal metastases. 23,41 Despite the low rates of isolated supradiaphragmatic relapses, chest imaging with CT or Xray is described in many followup protocols, 10,11,13 although the NCCN guidelines reserve chest imaging for patients with thoracic symptoms. 12 At the Princess Margaret Cancer…”

“…[2][3][4][5][6][7][8][9] Published guidelines for testicular seminoma provide consistent treatment recommendations, but followup schedules vary. [10][11][12][13][14] The aim of followup after cancer treatment is to detect and manage relapse, but monitoring and treating toxicity from therapy is also necessary. We reviewed the literature and the Princess Margaret Cancer Centre experience regarding followup of stage I and II testicular seminoma and make recommendations for an evidencebased followup approach.…”

Diagnostik, Therapie und Nachsorge beim Hodenkarzinom

“…Gleichzeitig sollten aber unnötige Strahlenbelastungen durch Computertomografien vermieden werden, deshalb wurden in der Folge Nachsorgecomputertomografien sukzessive durch Sonografien und konventionelle Röntgenuntersuchungen ersetzt. 2010 wurde von einer Deutsch/Österreichisch/Schweizerischen Expertengruppe ein umfassendes Nachsorgeprogramm publiziert [11], das nach wie vor die aktuelle Datenlage widerspiegelt.…”

Is There Still an Indication for Radiotherapy in Seminoma Clinical Stages I–IIA/B?

“…Thus control examinations are largely based on imaging procedures. As cumulative diagnostic radiation exposure may result in a small but well-recognized excess risk of second cancer [ 16 -18 ], application of computed tomography should be restricted to no more than four abdominopelvic CTs during the fi rst 2 years of follow-up to be followed by ultrasonographic examinations thereafter [ 19 ] with MR as an (resource-requiring) alternative [ 20 ].…”