Safety of Minimizing Intensity of Follow-up on Active Surveillance for Clinical Stage I Testicular Germ Cell Tumors

Gariscsak, Peter; Anson‐Cartwright, Lynn; Atenafu, Eshetu G.; Jiang, Di Maria; Chung, Peter; Bédard, Philippe L.; Warde, Padraig; O’Malley, Martin; Sweet, Joan; Glicksman, Rachel; Hamilton, Robert J.

doi:10.1016/j.euros.2022.03.010

Cited by 13 publications

(10 citation statements)

References 31 publications

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“…A case series of 1583 patients surveilled in Canada found that the death rate remained unchanged from 1981 to 2020. 105 If rising tumor markers occur after orchiectomy without evidence of metastases on imaging (stage I), patients should undergo systemic chemotherapy. 29 Stage II seminoma Stage II disease includes patients with metastatic spread into retroperitoneal lymph nodes.…”

Section: Stage I Seminomamentioning

confidence: 99%

“…Computed tomography scanning was reduced to 5-10 scans of the abdomen with or without the pelvis (computed tomography of the pelvis is added when the patient has a history of scrotal surgery, vasectomy, inguinal hernia, or undescended testicle) and the number of chest x ray images decreased from up to 30 to between 0 and 10. Some institutions utilize low dose computed tomography for chest scanning 91105. Even though the surveillance protocols are less intensive nowadays, no difference in relapse burden has been observed in terms of lymph nodes, visceral metastases, serum tumor markers, or IGCCCG risk group.…”

Section: Management Of Gctsmentioning

confidence: 99%

“…Even though the surveillance protocols are less intensive nowadays, no difference in relapse burden has been observed in terms of lymph nodes, visceral metastases, serum tumor markers, or IGCCCG risk group. A case series of 1583 patients surveilled in Canada found that the death rate remained unchanged from 1981 to 2020 105…”

Section: Management Of Gctsmentioning

confidence: 99%

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Advances in diagnosis and treatment of testicular cancer

Chovanec

Cheng

2022

BMJ

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Testicular cancer is a curable cancer. The success of physicians in curing the disease is underpinned by multidisciplinary advances. Cisplatin-based combination chemotherapy and the refinement of post-chemotherapy surgical procedures and diagnostic strategies have greatly improved long term survival in most patients. Despite such excellent outcomes, several controversial dilemmas exist in the approaches to clinical stage I disease, salvage chemotherapy, post-chemotherapy surgical procedures, and implementing innovative imaging studies. Relapse after salvage chemotherapy has a poor prognosis and the optimal treatment is not apparent. Recent research has provided insight into the molecular mechanisms underlying cisplatin resistance. Phase 2 studies with targeted agents have failed to show adequate efficacy; however, our understanding of cisplatin resistant disease is rapidly expanding. This review summarizes recent advances and discusses relevant issues in the biology and management of testicular cancer.

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Section: Stage I Seminomamentioning

confidence: 99%

Section: Management Of Gctsmentioning

confidence: 99%

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Advances in diagnosis and treatment of testicular cancer

Chovanec

Cheng

2022

BMJ

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“…As we place increasing focus on the quality of survivorship after a testicular cancer diagnosis, late effects become relevant. Although radiation associated with a single computerized tomography (CT) scan is significantly less than therapeutic radiation doses, the risks associated with cumulative exposure are increasingly recognized 19 and ultra-low–dose strategies are used at some centers to mitigate hazards. 20 The additive value of pelvic imaging has recently been examined by other contemporary data sets.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Relapse in Australian Patients With Clinical Stage 1 Testicular Cancer: Utility of the Australian and New Zealand Urogenital and Prostate Cancer Trials Group Surveillance Recommendations

Conduit

Lewin

Weickhardt

et al. 2023

JCO Oncology Practice

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PURPOSE: International guidelines advocate for active surveillance as the preferred treatment strategy for patients with stage 1 testicular cancer after orchidectomy although a personalized discussion is required. MATERIALS AND METHODS: We conducted an analysis of individuals registered in iTestis, Australia's testicular cancer registry, to describe the patterns of relapse and outcomes of patients treated in Australia where the Australian and New Zealand Urogenital and Prostate Cancer Trials Group Surveillance Recommendations are widely adopted. RESULTS: A total of 650 individuals diagnosed between 2000 and 2020 were included, 63% (411 of 650) seminoma and 37% (239 of 650) nonseminoma. The median age was 34 years (range 14-74). 26% (106 of 411) with seminoma and 15% (36 of 239) nonseminoma received adjuvant chemotherapy. After a median follow-up of 43 months (range 0-267) postorchidectomy, relapse occurred in 10% (43 of 411) of seminoma and 18% (43 of 239) of nonseminoma. The two-year relapse-free survival was 92% (95% CI, 89 to 95) and 82% (95% CI, 78 to 87) in seminoma and nonseminoma, respectively. All relapses (86 of 86) were detected at a routine surveillance visit; 98% (85 of 86) were asymptomatic and detected solely through imaging (62 of 86, 72%), tumor markers (6 of 86, 7%), or a combination (17 of 86, 20%). The most common relapse site was isolated retroperitoneal lymphadenopathy (53 of 86, 62%). No nonpulmonary visceral metastases occurred. At relapse, 98% (84 of 86) had International Germ Cell Cancer Collaborative Group (IGCCCG) good prognosis; 2 of 86 intermediate prognosis (both nonseminoma). No deaths occurred. CONCLUSION: In our cohort of stage 1 testicular cancer, where national surveillance recommendations have been widely adopted, recurrences were detected at routine surveillance visits and, almost exclusively, asymptomatic with IGCCCG good-prognosis disease. This provides reassurance that active surveillance is safe.

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“…The somewhat inconsistent recommendations include a high number of chest X-rays according to the EAU/ESMO and more abdominal CT scans according to the NCCN guideline. The difference in chest imaging between the SWENOTECA protocols (no chest imaging) and the Toronto group (five chest CTs) during follow-up is remarkable [25] .…”

Section: Evidence Synthesismentioning

confidence: 92%