Temporal trends in management and outcomes of testicular cancer: A population‐based study

Leveridge, Michael; Siemens, D. Robert; Brennan, Kelly; Izard, Jason; Karim, Safiya; An, Howard; Mackillop, William J.; Booth, Christopher M.

doi:10.1002/cncr.31390

Cited by 22 publications

(23 citation statements)

References 24 publications

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“…One treatment option for patients with retroperitoneal metastases is RPLND. Approximately 25% of all patients with non‐seminoma undergo RPLND during all treatments 6 . With regard to sexual functioning, the most significant complication of a standard bilateral (full template) RPLND is the loss of antegrade ejaculation.…”

Section: Introductionmentioning

confidence: 99%

Impact of cancer therapy on post‐treatment ejaculation disorder and sexual life in testicular cancer survivors

et al. 2020

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ObjectiveTo evaluate the impact of cancer therapy on post‐treatment ejaculation in patients with testicular cancer.MethodsA total of 74 testicular cancer survivors provided completed International Index of Erectile Function‐15 questionnaires before and after treatment between 2010 and 2017. Sexual function, particularly ejaculatory function, was evaluated before and after treatment. In this study, patients who answered “1 = almost never/never” or “2 = a few times” for questionnaire number 9 (ejaculation frequency) were defined as having “ejaculation disorder.”ResultsOf 74 testicular cancer survivors, 50 (68%) had no ejaculation disorders before treatment. Four (44%) of nine survivors, who received chemotherapy and retroperitoneal lymph node dissection, developed ejaculation disorders after treatment. On multivariate analysis, retroperitoneal lymph node dissection was a significant predictor of post‐treatment ejaculation disorder (P = 0.042). Of 60 survivors with evaluable ejaculation function after treatment, 24 (40%) did not attempt sexual intercourse, and multivariate analysis showed ejaculation disorder had a significant negative impact on having sexual intercourse (P = 0.035). Furthermore, the mean International Index of Erectile Function‐15 scores in the groups with and without ejaculation disorders after treatment were 24.0 and 51.9, respectively (P < 0.001).ConclusionEjaculation disorders occur at high rate after retroperitoneal lymph node dissection. Many testicular cancer survivors reporting no sexual intercourse have ejaculation disorders, suggesting an adverse impact on sexual life. Urologists should provide proper counselling regarding the risk of ejaculation disorder and its possible impact on sexual life.

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Section: Introductionmentioning

confidence: 99%

Impact of cancer therapy on post‐treatment ejaculation disorder and sexual life in testicular cancer survivors

et al. 2020

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“…As with our study, the majority of recurrences occurred within 5 yr, consistent with our median time to relapse of 55 mo. CS1 disease comprised only 30% of our LR cohort, whereas 50% of NSGCT cases are CS1 at presentation [10] , [11] . The risk of LR in CS≥2, accounting for 70% of our cases, would therefore appear to be significantly greater and occurs much later, with a median interval of 10 yr in this group.…”

Section: Discussionmentioning

confidence: 99%

Features and Management of Late Relapse of Nonseminomatous Germ Cell Tumour

Jay

Aldiwani

O’Callaghan

et al. 2021

European Urology Open Science

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Background Late relapse (LR) of nonseminomatous germ cell tumour (NSGCT) is uncommon, with limited data published. LR is defined as relapse occurring after a disease-free interval of 2 yr. Objective To review features of NSGCT LR in a UK tertiary centre. Design, setting, and participants A total of 3064 patients were referred from January 2005 to December 2017. We identified patients who experienced LR after initial pathology demonstrated NSGCT and reviewed data for their original and LR presentation and management. Outcome measurements and statistical analysis Outcomes included time to LR measured from the date of diagnosis, and overall survival. This was assessed using Cox proportional Hazards modelling, with stratification or adjustment for potential confounders. Results and limitations We identified 101 patients with LR; the median time to LR was 96 mo. Forty-three patients (42.6%) experienced relapse after 10 yr. Univariable log-rank testing revealed that the median time to LR was significantly shorter for patients who had not received induction chemotherapy (iCTx; 54 mo, 95% confidence interval [CI] 48–108) than for those who did (112 mo, 95% CI 84–186; p = 0.04). Patients who had received iCTx were less likely to have elevated tumour markers (36% vs 46%) and more likely to undergo initial surgical resection at LR compared to CTx-naïve patients. Postpubertal teratoma (PPT), yolk sac, and dedifferentiated elements predominated for patients with iCTx exposure, whereas active GCT or fibrosis predominated in postchemotherapy resections for CTx-naïve patients at LR. Forty-one men underwent postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) as part of their initial treatment for metastatic disease. Of these, 20 experienced LR in the retroperitoneum, with 18 undergoing repeat RPLND as part of their LR management. Fifteen of the repeat RPLND histopathology specimens had a PPT component. There have been 23 deaths overall; survival was worse for patients presenting with symptoms (13/36, 33%) and those receiving CTx and no surgery (10/17, 59%) at LR. Conclusions When LR of NSGCT occurs, it is frequently after an extended interval and is later among patients with prior iCTx, with PPT predominating. The high frequency of LR within the retroperitoneum following PC-RPLND reinforces the need for good-quality PC-RPLND. Patient summary We reviewed data for patients who had a late relapse of testicular cancer. We found that patients who did not receive chemotherapy as the first treatment for their initial diagnosis had a shorter time to relapse. Our results highlight the importance of long-term follow-up for testicular cancer.

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“…Seminal publications over the past 2 decades have led to a paradigm shift in the treatment of early-stage testicular seminoma, with a trend toward judicious surveillance and deintensification of therapy [3,10,11]. Given the high probability for cure, the oncologic community has become more mindful of the morbidity associated with treatment, as both adjuvant chemotherapy and radiation therapy have inherent long-term risks [12].…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Toxicities of Proton and Photon Radiation Therapy for Testicular Seminoma

Pasalic

Prajapati

Ludmir

et al. 2020

International Journal of Particle Therapy

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Purpose To determine the clinical outcomes and toxicities of proton beam therapy (PBT) versus 3D-conformal photon radiation therapy (XRT) in patients with testicular seminoma. Materials and Methods This observational study evaluated consecutive patients with testicular seminoma who were treated with inguinal orchiectomy and radiation therapy at a single, tertiary, high-volume center in 2008-19. Acute toxicity was scored with the Common Terminology Criteria for Adverse Events V 4.0. Organs at risk were contoured retrospectively by 2 investigators. Recurrences and secondary malignancies were based on routine follow-up imaging, either computed tomography or magnetic resonance imaging. Results Fifty-five patients were treated with radiation therapy, 11 in the PBT-arm and 44 in the XRT-arm, with a median follow-up interval of 61 months (interquartile range [IQR]: 32-79 months). Acute treatment-related diarrhea, grade 1 to 2, was more common among XRT-treated patients (0% vs 29.5%, P = .039), and dermatitis, grade 1, was more likely among PBT-treated patients (27.3% vs 2.3%, P = .004). Dosimetrically, PBT-treated patients, relative to XRT-treated patients, had lower dose to organs at risk including the kidney, bladder, femoral head, spinal cord, bowel, pancreas, and stomach. The 5-year overall survival rate was 100% and disease-free survival rate was 96.4% for all patients. Two patients, all in the XRT-arm, had disease recurrence: 1 in the pelvis and 1 in the lung. Three patients, all in the XRT-arm, were diagnosed with a secondary malignancy: 1 in-field pancreaticoblastoma, 1 in-field colon adenocarcinoma, and a stage IV T-cell lymphoma. Conclusion Proton beam therapy for testicular seminoma resulted in excellent clinical outcomes and was associated with lower rates of acute diarrhea but higher rates of acute dermatitis. Proton beam therapy resulted in no in-field secondary malignancies and a more favorable dosimetric profile for organs at risk relative to XRT. Reduced dose to organs at risk, such as the kidneys, may result in long-term improvement in function.

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Temporal trends in management and outcomes of testicular cancer: A population‐based study

Abstract: There has been substantial de-escalation in the treatment of testicular cancer in routine practice since 2000. Long-term survival in routine practice is excellent and has not decreased with the uptake of surveillance strategies. Cancer 2018;124:2724-2732. © 2018 American Cancer Society.

Cited by 22 publications

References 24 publications

Impact of cancer therapy on post‐treatment ejaculation disorder and sexual life in testicular cancer survivors

Impact of cancer therapy on post‐treatment ejaculation disorder and sexual life in testicular cancer survivors

Features and Management of Late Relapse of Nonseminomatous Germ Cell Tumour

Outcomes and Toxicities of Proton and Photon Radiation Therapy for Testicular Seminoma

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