New Guidelines for Clinical Stage I Testicular Seminoma?

Christoph, Frank; Weikert, Steffen; Miller, Kurt; Schrader, Mark

doi:10.1159/000090493

Cited by 3 publications

(3 citation statements)

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“…Although no clear predictors of relapse were found, lymphovascular invasion, rete testis invasion and tumor size have all been reported to significantly increase the risk of relapse in patients with seminoma [24]. In our series, all 3 patients presenting with relapse demonstrated large tumors on initial pathological assessment (4.6, 6, 8 cm).…”

Section: Discussionmentioning

confidence: 55%

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

et al. 2012

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BackgroundThe aim of this report is to address treatment outcomes of patients with early-stage seminoma in a single institution with special reference to patients with history of surgical violation of the scrotum.MethodsSeventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months).ResultsAt the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy.ConclusionsOur results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum are effective measures in preventing local failure.

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Section: Discussionmentioning

confidence: 55%

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

et al. 2012

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“…Determining the incidence rates of secondary malignancies in those men diagnosed with CSIS is extremely important because this represents the largest subset of men affected by germ cell malignancies and also because defining treatment complications could influence management decisions and guide long‐term follow‐up strategies. Historically, adjuvant radiotherapy to the retroperitoneum was the standard of care for CSIS after orchiectomy [11]. However, the adverse risks associated with ionizing radiation in men with germ cell cancers have now been reported in numerous series [12–18].…”

Section: Discussionmentioning

confidence: 99%

“…Until recently, receipt of adjuvant EBRT has been the standard of care for patients with CSIS [ 11 ] . Unfortunately, receipt of adjuvant EBRT for CSIS is unnecessary in ≈ 80% of patients because only 20% of patients with CSIS will experience relapse with close observation alone [ 7 ] .…”

Section: Introductionmentioning

confidence: 99%

Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma

et al. 2011

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What ' s known on the subject? and What does the study add? We know that radiation therapy is associated with an increased risk of second malignancies in patients with testicular cancer. However, we know that radiation is being used very commonly in patients with clinical stage I seminoma, despite evidence that it is not required. Moreover, we have now identifi ed which specifi c second malignancies occur in these patients after radiotherapy. OBJECTIVES• To determine the use of adjuvant external beam radiotherapy (EBRT) for patients with clinical stage I testicular seminoma in the USA.• To quantify the risk of specifi c second primary malignancies (SPMs) associated with radiation exposure in these patients. PATIENTS AND METHODS• We used the Surveillance, Epidemiology and End Results database to identify patients diagnosed with clinical stage I testicular seminoma between 1973 and 2000.• We evaluated the use of EBRT in these patients.• We calculated standardized incidence ratios of specifi c SPMs in these patients.• We stratifi ed the incidence of SPMs based on age at seminoma diagnosis and time to SPM from initial seminoma diagnosis. RESULTS• Adjuvant EBRT use declined from the fi rst decade of the study period to the last decade of the study period (80.6% vs 70.2%).• Overall, there was a 19% increase in SPMs in patients exposed to EBRT (observed/expected, O/E, 1.51; 95% CI, 1.08 -1.31) compared to the general population.• Specifi cally, signifi cantly increased risks were observed for thyroid cancer (O/E, 2.32; 95% CI, 1.16 -4.16), pancreatic cancer (O/E, 2.38; 95% CI, 1.43 -3.72), non-bladder urothelial malignancies (O/E, 4.27; 95% CI, 1.57 -9.29), bladder cancer (O/E, 1.47; 95% CI, 1.01 -2.28), all haematological malignancies (O/E, 1.44; 95% CI, 1.08 -1.89) and non-Hodgkin ' s lymphoma (O/E, 1.77; 95% CI, 1.22 -2.48).• Patients had a persistently elevated risk of SPMs 15 years from the time of initial clinical stage I testicular seminoma diagnosis (O/E, 1.29; 95% CI, 1.10 -1.49). CONCLUSIONS• We confi rmed the increased risk of SPMs after EBRT for seminoma, and we identifi ed the specifi c types of SPMs that develop.• The risk of EBRT-associated SPM persists for years after the initial seminoma diagnosis, and patients should be informed about these long-term risks.

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Exploration of treatment options for the management of stage I testicular seminoma

Bernal¹,

Raman²

2008

Expert Review of Anticancer Therapy

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Seminoma is the epitome of a highly treatable neoplastic malignancy. Approximately 80% of patients presenting with seminomatous germ cell tumors are diagnosed with stage I disease. Men with clinical stage I seminomas have an excellent chance of achieving a cure irrespective of the treatment option selected. With such high disease-specific survival rates, attention has turned to reducing treatment-related morbidity. Adjuvant radiotherapy to the para-aortic retroperitoneal lymph nodes in conjunction with orchidectomy has been the standard treatment since the mid-1990s. There is some evidence, however, suggesting potential deleterious long-term sequelae from radiation treatment. Adjuvant chemotherapy has gained support as an acceptable adjuvant treatment strategy for stage I seminoma. While long-term studies are limited, short-term data regarding the therapeutic efficacy of single-agent carboplatin are promising. Finally, surveillance following orchidectomy is an attractive option for motivated patients interested in avoiding immediate adjuvant therapy. It may be the optimal choice for compliant men who are able to handle the mental burden of not receiving active treatment.

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New Guidelines for Clinical Stage I Testicular Seminoma?

Cited by 3 publications

References 82 publications

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma

Exploration of treatment options for the management of stage I testicular seminoma

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