Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party.

Read, G.; Stenning, Sally; Cullen, M. H.; Parkinson, M. C.; Horwich, A.; Kaye, Stanley B.; Cook, Pat

doi:10.1200/jco.1992.10.11.1762

Cited by 399 publications

(223 citation statements)

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“…In the original prospective study, 80% (of 100 relapses) occurred within the first year (54 of these in the first 6 months) and 92% by 2 years (Read et al, 1992). A number of subsequent studies have demonstrated similar results and are summarised in Table 1.…”

Section: Stages Iic -Ivmentioning

confidence: 82%

“…Surveillance as a strategy for the management of stage I tumours was prospectively studied by the Medical Research Council and their results were published in 1992 (Read et al, 1992). In the absence of high-risk features where relapse rates approach 50%, among the usual population undergoing surveillance a relapse rate of around 20% is to be expected.…”

Section: Stages Iic -Ivmentioning

confidence: 99%

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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: 82%

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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“…Presence of embryonal cell carcinoma, absence of endodermal sinus tumour and invasion of tumour cells into blood and lymphatic vessels have been found to be predictors of relapse [1,12,13]. Subsequent studies have shown that vascular invasion (VI) is the single most important prognostic factor regarding risk of relapse [14][15][16][17].…”

Section: Prognostic Risk Factorsmentioning

confidence: 99%

“…Subsequent studies have shown that vascular invasion (VI) is the single most important prognostic factor regarding risk of relapse [14][15][16][17]. Without adjuvant treatment, the high-risk group (VI positive) has a 3-year relapse rate of approximately 50%, while low-risk patients (VI negative) have a relapse risk of 10 to 20% [1,3,[16][17][18][19][20][21][22].…”

Section: Prognostic Risk Factorsmentioning

confidence: 99%

“…The controversy however remains over the choice of modality since patients have an excellent survival with all the modalities with cancer-specific survival rates of 98 to 99%. Furthermore, from large surveillance series, we know that 25 to 30% of patients diagnosed with CS1 disease ultimately will relapse due to occult microscopic retroperitoneal lymph node metastases, which cannot be reliably detected by modern imaging studies, tumour markers or molecular approaches [1][2][3]. The risks and benefits of treatment modalities differ [4].…”

Section: Introductionmentioning

confidence: 99%

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Current Concepts in Management of Stage I NSGCT

Ahluwalia

Gautam

2016

Indian J Surg Oncol

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While about 50% of non-seminomatous germ cell tumors of the testes present as clinical stage I (CSI), further management of these patients continues to be mired in controversy. Active surveillance is a frontline option for low-risk CS I patients and according to some, even the high-risk ones with high embryonal carcinoma (ECA) component and vascular invasion (VI). However, it carries the disadvantage of long-term surveillance, the need for prolonged chemotherapy in case of recurrence and the possibility of secondary malignancies due to radiation exposure from frequent CT scans. One or two cycles of BEP chemotherapy is a popular alternative to active surveillance which carries a very low relapse rate, but valid concerns about overtreatment of a majority of patients, with the attendant chemotherapy-related toxicity exist. Retroperitoneal lymph node dissection has been used as a means of avoiding chemotherapy, especially in high-risk patients, but carries the disadvantage of a high surgical morbidity and complications. As with any major surgical procedure, the best results are dependent on the experience and skill of the individual surgeon.

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MIB-1 immunohistochemistry in clinical Stage I nonseminomatous testicular germ cell tumors predicts patients at low risk for metastasis

Albers¹,

Bierhoff

Neu

et al. 1997

Cancer

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This study in a different patient population with different investigators confirmed previous results of MIB-1 staining to predict a group of patients with clinical Stage I NSGCT who were at low risk for metastasis. The method is simple and reproducible to improve risk classification in low stage testicular carcinoma. Using this technique, a group of patients at very low risk for metastasis can be identified. [See editorial counterpoint on pages 1641-5 and reply to counterpoint on page 1646, this issue.]

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Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party.

Cited by 399 publications

References 9 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

Current Concepts in Management of Stage I NSGCT

MIB-1 immunohistochemistry in clinical Stage I nonseminomatous testicular germ cell tumors predicts patients at low risk for metastasis

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