Results of a policy of surveillance in stage I testicular seminoma

Warde, Padraig; Gospodarowicz, Mary K.; Goodman, Phyllis J.; Sturgeon, J.; Jewett, Michael A.S.; Catton, Charles; Richmond, Hugh M.; Thomas, Gillian; Duncan, W.; Munro, Alastair J.

doi:10.1016/0360-3016(93)90415-r

Cited by 68 publications

(8 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously noted, a growing body of evidence supports the use of close surveillance in patients with stage I seminoma; however, randomized data are lacking. 4,8,[10][11][12][13] The desire to avoid adjuvant treatment stems not only from the high cure rates with primary orchiectomy and Cancer the high rates of successful salvage therapy in those who experience recurrence but also from a growing understanding of the potential long-term morbidities of radiotherapy such as sexual dysfunction, cardiac disease, and radiation-associated cancers. [21][22][23][24][25][26][27] Novel radiotherapy delivery modalities and techniques may, however, serve to reduce these risks.…”

Section: Discussionmentioning

confidence: 99%

“…3 After orchiectomy and appropriate staging, data from large prospective trials and cohort studies support the efficacy of adjuvant radiotherapy, chemotherapy, or close surveillance. [4][5][6][7][8][9][10][11][12][13] Although evolving national practice guidelines support each of these management options for patients with stage IA/ B disease, close surveillance after orchiectomy has been recommended as the preferred method of management. 14 For patients with stage IS disease, adjuvant radiation therapy has historically been the standard of care, although the most appropriate management strategy for these patients has become less clear more recently.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management trends in stage I testicular seminoma: Impact of race, insurance status, and treatment facility

Gray

Lin

Sineshaw

et al. 2014

Cancer

View full text Add to dashboard Cite

BACKGROUND:The management of stage I testicular seminoma is evolving rapidly. This study examined modern trends in the management of stage I testicular seminoma and the effects of sociodemographic factors on therapy choice. METHODS: Data from the National Cancer Data Base on 34,067 patients with stage I testicular seminoma who were treated between 1998 and 2011 were analyzed. Multivariate logistic regression models were used to assess factors associated with adjuvant management strategies. RESULTS: For patients with stage IA/B testicular seminoma, rates of observation after orchiectomy increased from 23.7% to 54.0%, the receipt of adjuvant chemotherapy increased from 1.5% to 16.0%, and the receipt of radiotherapy decreased from 70.8% to 28.8%. A similar pattern was seen in stage IS testicular seminoma, although these patients were more likely to receive adjuvant radiotherapy/chemotherapy (60.7% vs 44.8% for stage IA/B in 2011, P <.001). For patients with stage IA/B testicular seminoma, observation after orchiectomy was more common in racial minorities (odds ratio [OR] for blacks vs whites, 1.31, P <.001; OR for Hispanics vs whites, 1.39, P <.001) and in the uninsured (OR for uninsured vs privately insured, 1.33, P <.001) and less common at community centers (OR for community centers vs National Cancer Institute-designated cancer centers, 0.80, P 5.044). In those with stage IA/B testicular seminoma who received adjuvant radiotherapy/chemotherapy, the receipt of chemotherapy was more common at academic centers and for patients with nonprivate insurance. CONCLUSIONS: Postorchiectomy observation in stage I testicular seminoma has increased significantly in recent years, as has the receipt of chemotherapy, whereas the receipt of radiotherapy has declined, particularly at academic centers. Race, insurance status, and facility type are strongly associated with the choice of adjuvant management. Cancer 2015;121:681-7.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management trends in stage I testicular seminoma: Impact of race, insurance status, and treatment facility

Gray

Lin

Sineshaw

et al. 2014

Cancer

View full text Add to dashboard Cite

show abstract

“…A clinical implication of this result is that especially the childless older seminoma patients should undergo treatment which is as fertility-saving as possible in order to allow a maximum recovery of the spermatogenesis. These arguments strongly favour the application of a wait-and-see policy in patients who want to father a child after diagnosis (Warde et al, 1993).…”

Section: mentioning

confidence: 99%

Fertility in Norwegian testicular cancer patients

Fosså

Kravdal

2000

Br J Cancer

View full text Add to dashboard Cite

The intention was to explore the relationship between fertility and testicular cancer, including the possibly treatment-induced changes over time in the post-diagnostic fertility. Data are from the Norwegian Cancer Registry, The Norwegian Population Register and the Population Censuses. By estimating Poisson regression models, birth rates among testicular cancer patients were compared with those of other men who had the same age, parity and duration since previous birth. Poisson regression models were also estimated to check whether men's parity has an effect on the cancer incidence. Fertility rates among testicular cancer patients born after 1935 and treated before 1991 decreased by roughly 30% when compared with the normal population. The introduction of cisplatin chemotherapy and of nerve-sparing RPLND in the 1980s seems to have enabled more patients with non-seminoma to father a child after treatment, or at least shortened the time to conception. Moreover, the risk of being diagnosed with seminoma is reduced with increasing parity. This suggests that the relatively low fertility after diagnosis may be partly due to the continuing inherent influence of a sub- or infecundity that also had a bearing on the development of the disease. © 2000 Cancer Research Campaign

show abstract

“…As the majority of patients are treated in young adult life and do not need chemotherapy, they represent a group in whom the long-term radiotherapy risks are relevant and are measurable where population health records are available. Surveillance studies suggest that about 18–20% of these patients have subclinical abdominal node metastases (Horwich et al , 1992; von der Maase et al , 1993; Warde et al , 1993) and thus have the potential to gain from adjuvant radiotherapy. As the great majority of patients are cured, there is concern over radiation carcinogenesis (van Leeuwen et al , 1993; Horwich and Bell, 1994; Travis et al , 1997; Richiardi et al , 2007; Hemminki et al , 2010) and over other possible late radiation effects (Zagars et al , 2004).…”

mentioning

confidence: 99%

Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma

Horwich¹,

Fosså

Huddart³

et al. 2013

Br J Cancer

View full text Add to dashboard Cite

Background:Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant.Methods:We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51 151 person-years of follow-up.Results:Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47–1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39–1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic–abdominal sites the SIR was 1.62 (95% CI: 1.43–1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98–1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30–1.65, P<0.0001).Conclusion:The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers.

show abstract

Results of a policy of surveillance in stage I testicular seminoma

Cited by 68 publications

References 14 publications

Management trends in stage I testicular seminoma: Impact of race, insurance status, and treatment facility

Management trends in stage I testicular seminoma: Impact of race, insurance status, and treatment facility

Fertility in Norwegian testicular cancer patients

Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma

Contact Info

Product

Resources

About