Low-Volume Nodal Metastases Detected at Retroperitoneal Lymphadenectomy for Testicular Cancer: Pattern and Prognostic Factors for Relapse

Rabbani, Farhang; Sheinfeld, Joel; Farivar-Mohseni, Hesam; Léon, Antonio; Rentzepis, Michael; Reuter, Victor E.; Herr, Harry W.; McCaffrey, John; Motzer, Robert J.; Bajorin, Dean F.; Bosl, George J.

doi:10.1200/jco.2001.19.7.2020

Cited by 93 publications

(37 citation statements)

References 23 publications

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“…Although different GCTs have variable metastatic potential, these tumors, nevertheless, follow a uniform dissemination pattern extending to the retroperitoneal lymph nodes as the first site of metastatic dissemination. 10 Predictable spread of GCT allows for directed clinical and pathological staging followed by adjuvant, combinational or salvage treatment if indicated. Furthermore, prophylactic treatment of occult microscopic metastasis is clinically relevant because of the significant degree of understaging and the potential toxicity of adjuvant therapy.…”

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confidence: 99%

Mismatch repair expression in testicular cancer predicts recurrence and survival

Velasco

Corvalán

Wistuba

et al. 2007

Intl Journal of Cancer

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We investigated mismatch repair (MMR) gene expression in testicular cancer as a molecular marker for clinical outcome (recurrence, response to chemotherapy and death) using protein expression and specific genetic alterations associated with the presence or absence of MMR activity. One hundred sixty-two cases of paraffin-embedded testis cancer specimens were subjected to immunohistochemical analysis using monoclonal antibody for MLH1 and MSH2 MMR proteins and genetic analysis using specific polymorphic markers. The degree of MMR immunoreactivity and genetic instability in the form of loss of heterozygosity (LOH) and/ or microsatellite instability (MSI) were determined by comparing matched normal and tumor tissue. The degree of immunohistochemical staining for MMR expression was associated with a shorter time to tumor recurrence, resistance to chemotherapy and death. Furthermore, clinical relapse and cancer specific death was also associated with tumors exhibiting a high degree of MSI, p 5 0.01 and 0.04, respectively. In contrast, LOH was not associated with recurrence, resistance to chemotherapy or death. Therefore, MMR expression defines testis cancers with distinct molecular properties and clinical behavior, such that tumors with decreased MMR immunostaining and/or increased frequency of MSI have a shorter time to recurrence and death despite chemotherapy. ' 2007 Wiley-Liss, Inc.

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confidence: 99%

Mismatch repair expression in testicular cancer predicts recurrence and survival

Velasco

Corvalán

Wistuba

et al. 2007

Intl Journal of Cancer

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“…In patients with low-volume (N1) retroperitoneal disease, surgical cure is possible with surgery only and without adjuvant chemotherapy [23][24][25]. The outcomes of 464 patients with CS I NSGCT were reviewed by Donohue et al with a mean follow-up of 96.2 months [26].…”

Section: Rplndmentioning

confidence: 99%

Current Update of Management of Clinical Stage I Non Seminomatous Germ Cell Tumors of Testis

Yuvaraja

2012

Indian J Surg Oncol

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The management of patients with testicular germ cell tumors (GCT) has evolved significantly over the past 30 years with cure rates approaching nearly 100% for lowstage disease and more than 80% for advanced disease. Controversy surrounds about ideal management of clinical stage I non seminomatous germ cell tumors (CS I NSGCT) of the testis due to multiple treatment options available with more or less equal efficacy. Nerve-sparing retroperitoneal lymph node dissection (RPLND), adjuvant chemotherapy with two cycles of bleomycin, etoposide, and cisplatin , or surveillance have all achieved long-term survival in nearly 100% of patients with clinical stage I NSGCT. Retroperitoneal lymph node dissection is still favoured as the therapy of choice for clinical stage I non-seminomatous germ cell tumors in many centres, but as risk factors for the primary tumor have become better understood, surveillance and riskadapted therapy, including surveillance for low-risk patients and adjuvant chemotherapy for the high-risk group, is now being considered a therapeutic option. The objective of this study is to review current developments in the management of CS I NSGCT testis with emphasis on risk stratification and treatment recommendations.

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“…In patients with low volume retroperitoneal metastatic disease, surgical cure with retroperitoneal lymph node dissection only and without adjuvant chemotherapy occurs at the 65% to 90% level. [43][44][45][46] Indiana University reported on the outcome of 464 patients with CS1 NSGCT from 1965-1989 with a mean follow-up of 96.2 months. 47 In this analysis, 323 (70%) patients had pathologic stage A (PSA) disease with 37 (11%) relapsing, with an overall survival of 99.4%.…”

Section: Primary Rplndmentioning

confidence: 99%

Optimal management of testicular cancer: from self-examination to treatment of advanced disease

Beck¹

2010

OAJU

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Germ-cell cancer is the most common solid tumor in men aged 15 to 35 years and has become the model for curable neoplasm. Over the last 3 decades, the cure rate has increased from 15% to 85%. This improved cure rate has been largely attributed to the introduction of cisplatin-based chemotherapy. In stage I seminoma and nonseminoma, cure rates approach 100% and treatment is governed by patient choice based on the perceived morbidities of each therapy and personal preferences. For seminoma, treatments include surveillance, radiotherapy, and single course carboplatin. For nonseminoma, treatments include surveillance, retroperitoneal lymph node dissection (RPLND), and adjuvant chemotherapy. Low volume (<3 cm) stage II seminoma is typically managed with radiotherapy while higher volume (>3 cm) stage II and stage III disease treated with chemotherapy. Positron emission tomography (PET) imaging can differentiate active cancer versus necrosis for postchemotherapy residual masses. PET-positive masses are managed with either surgery or second-line chemotherapy. Low volume (,5 cm) stage II nonseminoma with normal serum tumor markers may be managed with either RPLND or chemotherapy. Patients with persistently elevated serum tumor markers and larger volume stage II and stage III disease are managed with systemic chemotherapy. As with seminoma, good risk patients are typically treated with 3 courses of bleomycin, etoposide, and cisplatin (BEP) and intermediate and poor risk patients are treated with 4 courses. Residual postchemotherapy masses should be resected due to the uncertainty of the histology with 50% to 60% harboring residual teratoma or active cancer. The majority of patients completing initial therapy who relapse do so within 2 years. A minority of patients (2%-3%) recur after 2 years and this phenomenon is termed late relapse. Excluding chemonaïve patients, late relapse disease is typically managed surgically with 50% being cured of disease. Current therapeutic challenges in testis cancer include the accurate prediction of postchemotherapy histology to avoid surgery in patients harboring fibrosis only, improved therapy in platinum-resistant and platinum-refractory disease, and the understanding of the biology of late relapse.

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Low-Volume Nodal Metastases Detected at Retroperitoneal Lymphadenectomy for Testicular Cancer: Pattern and Prognostic Factors for Relapse

Cited by 93 publications

References 23 publications

Mismatch repair expression in testicular cancer predicts recurrence and survival

Mismatch repair expression in testicular cancer predicts recurrence and survival

Current Update of Management of Clinical Stage I Non Seminomatous Germ Cell Tumors of Testis

Optimal management of testicular cancer: from self-examination to treatment of advanced disease

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