Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan-Kettering Cancer Center.

Puc, Heide S.; Heelan, Robert T.; Mazumdar, Madhu; Herr, Harry W.; M.D., J.D. Noah S. Scheinfeld; Vlamis, Vaia; Bajorin, Dean F.; Bosl, George J.; Mencel, Peter; Motzer, Robert J.

doi:10.1200/jco.1996.14.2.454

Cited by 170 publications

(70 citation statements)

References 19 publications

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“…Attempted surgical removal can be difficult. In most cases, the masses will resolve in time, but if larger than 3 cm the chance of active malignancy is higher (Puc et al, 1996). If PET scanning is available, then data from De Santis et al (2004) suggests that 80% of patients with active disease can be identified and should be undertaken for masses 43 cm.…”

Section: Stages Iic -Ivmentioning

confidence: 99%

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

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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Testicular germ cell tumours (TGCTs) are the most common cause of cancer in men between the ages of 15 and 40 years, and, overall, the majority of patients should expect to be cured. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma and nonseminomatous germ cell tumours. There is, however, no international consensus on how best to follow patients after their initial management. This must promptly and reliably identify relapses without causing further harm. The standardising of follow-up would result in optimising risk-benefit ratios for individual patients, while ensuring economic use of resources. We have identified the seven common scenarios in managing seminomas and nonseminomas of the various stages and discuss the pertinent issues around relapse and follow-up. We review the available literature and present our comprehensive TGCT follow-up guidelines. Our protocols provide a pragmatic, easily accessible user-friendly basis for other centres to use or to adapt to suit their needs. Furthermore, this should enable future trials to address specific issues around follow-up giving meaningful and useful results. BackgroundTesticular germ cell tumours (TGCTs) are uncommon malignancies but the most common cause of cancer in men between the ages of 15 and 40 years. The peak incidence for nonseminomatous germ cell tumour (NSGCT) is between 20 and 30 years of age, and for seminoma between 30 and 40 years. In the United Kingdom, the incidence rate is only 1 : 100 000 men per year with a lifetime risk of developing a TGCT of 1 in 400 and 1900 new cases per year (Horwich, 2002). There has, however, been a steady increase in the incidence of TGCTs in European countries in the last two decades (Bergstrom et al, 1996). The reasons for this increasing incidence and the aetiology of TGCTs remain unknown. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma tumour and NSGCT (Schmoll et al, 2004). There is, however, a lack of clear consensus on how to follow patients after primary treatment, and a number of issues dictate that follow-up should be carefully thought out and rigorously adhered to. Here, we discuss these factors as they pertain to male germ cell tumour (GCT) practice and describe our recently developed protocols. Rational for follow-upDetecting relapse In general, detecting relapse is the major reason for maintaining follow-up and is the main focus of this review. The management of testicular cancer has been a major oncological success story, and provides a model for the management of curative solid tumours (Horwich et al, 2006). The use of platinumbased chemotherapy schedules has resulted in high cure rates for all stages of the disease (International Germ Cell Cancer Collaborative Group, 1997). The fact that the majority of young men treated for testicular cancer have a durable response to primary treatment has resulted in the accumulation of significant data on both the patterns ...

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Section: Stages Iic -Ivmentioning

confidence: 99%

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

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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“…The positive predictive value and negative predictive value of FDG PET, irrespective of tumor size, were 100% and 96%, respectively.The two false negatives were seen in tumors #3 cm in size. Size .3 cm or #3 cm was confirmed to be a predictor of residual disease, as it has been in other series, with a cancer rate of 37% and 8%, respectively [7][8][9][10]. This series was followed up 1 year later and reported an additional false negative (3 of 11) in tumors ,3 cm but maintained its perfect positive predictive value for a final sensitivity and specificity of 80% and 100%, respectively [11].…”

Section: Imaging After Chemotherapymentioning

confidence: 59%

Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

et al. 2014

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Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.

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“…There is little evidence for routine adjuvant treatment after combination chemotherapy (Schultz et al, 1989;Duchesne et al, 1997). It has been suggested that residual masses more than 3 cm in diameter early in the period following chemotherapy may be at greater risk of containing viable seminoma (Motzer et al, 1988;Puc et al, 1996) and the protocol therefore recommended a biopsy of any residual mass more than 5 cm in diameter. In this trial, only 5 residual masses in 4 patients in this time period were resected (1) or biopsied (3) and one revealed viable seminoma.…”

Section: Discussionmentioning

confidence: 99%

A Medical Research Council randomized trial of single agent carboplatin versus etoposide and cisplatin for advanced metastatic seminoma

et al. 2000

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The UK Medical Research Council conducted this trial of carboplatin chemotherapy in advanced seminoma to compare single agent carboplatin with a standard combination of etoposide with cisplatin. The use of single agent carboplatin was expected to be associated with reduced toxicity. A total of 130 patients with advanced seminoma were randomly assigned to treatment with either single agent carboplatin (C) at a dose of 400 mg/m 2 to be corrected for glomerular filtration rate outside the range 81–120 ml min –1 and to be administered on day 1 of a 21 day cycle to a total of 4 cycles or to etoposide + platinum (EP). The trial was designed as an equivalence study aiming to exclude a reduction in the 3-year progression-free survival in patients allocated to carboplatin of between 10 and 15%, requiring initially a target accrual of 250 patients (90% power significance level 5% (one-sided)). The trial closed after 130 patients had been randomized following recommendation by an independent data monitoring committee. At a median follow-up time of 4.5 years, 81% of patients had been followed up for at least 3 years and 19 patients have died. The estimated PFS rate (95% Confidence Intervals (CI)) at 3 years was 71% (60–82%) in patients allocated C and 81% (71–90%) in those allocated EP; the 95% CI for the difference in 3 year PFS was – 6% to +19%. The hazard ratio of 0.64 (95% CI 0.32–1.28) favoured EP but the difference was not statistically significant (log rank chi-squared = 1.59 P = 0.21). The 3-year survival rate was 84% (75–92%) in those allocated C, and 89% (81–96%) in those allocated EP. The hazard ratio for survival was 0.85 with 95% CI, 0.35–2.10, log rank chi-squared = 0.12, P = 0.73. The trial has not demonstrated statistically significant differences in the major survival endpoints comparing single agent carboplatin with a combination of etoposide + cisplatin. This cannot be taken as an indication of equivalence since the limited size of this trial rendered it unable to exclude a 19% lower progression-free survival and survival in those treated with single agent carboplatin which would be important clinically. Standard initial chemotherapy for advanced seminoma should be based on cisplatin combinations and the role of carboplatin awaits the outcome of further studies. © 2000 Cancer Research Campaign http://www.bjcancer.com

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Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan-Kettering Cancer Center.

Cited by 170 publications

References 19 publications

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

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

Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

A Medical Research Council randomized trial of single agent carboplatin versus etoposide and cisplatin for advanced metastatic seminoma

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