Abstract
We believe that active surveillance is the optimal choice for compliant men who are able to handle the mental burden of not receiving adjuvant treatment. This takes into consideration the fact that a small number of men with clinical stage I (CSI) seminoma on surveillance will recur but are salvageable with equivalent outcome compared to those having adjuvant treatment which exposes eight in ten men to unnecessary short- and long-term risks with still the possibility of recurrence requiring salvation. This review will focus on CSI seminoma and the controversies surrounding its treatment and based upon current available evidence will outline the case for surveillance.
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Sant M, Aareleid T, Artioli ME et al (2007) Ten-year survival and risk of relapse for testicular cancer: a EUROCARE high resolution study. Eur J Cancer 43:585. doi:10.1016/j.ejca.2006.11.006
Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71. doi:10.3322/CA.2007.0010
Martin JM, Panzarella T, Zwahlen DR et al (2007) Evidence-based guidelines for following stage 1 seminoma. Cancer 109:2248. doi:10.1002/cncr.22674
Fleshner N, Warde P (2002) Controversies in the management of testicular seminoma. Semin Urol Oncol 20:227. doi:10.1053/suro.2002.36979
Samant R, Alomary I, Genest P et al (2008) Contemporary management of stage I testicular seminoma: a survey of Canadian radiation oncologists. Curr Oncol 15:168. doi:10.3747/co.v15i4.213
Groll RJ, Warde P, Jewett MA (2007) A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol 64:182. doi:10.1016/j.critrevonc.2007.04.014
Bernal F, Raman JD (2008) Exploration of treatment options for the management of stage I testicular seminoma. Expert Rev Anticancer Ther 8:1081. doi:10.1586/14737140.8.7.1081
Albers P (2007) Management of stage I testis cancer. Eur Urol 51:34. doi:10.1016/j.eururo.2006.08.022
Chia VM, Li Y, Goldin LR et al (2009) Risk of cancer in first- and second-degree relatives of testicular germ cell tumor cases and controls. Int J Cancer 124:952. doi:10.1002/ijc.23971
Akre O, Pettersson A, Richiardi L (2009) Risk of contralateral testicular cancer among men with unilaterally undescended testis: a meta analysis. Int J Cancer 124:687. doi:10.1002/ijc.23936
Cooper DE, L’Esperance JO, Christman MS et al (2008) Testis cancer: a 20-year epidemiological review of the experience at a regional military medical facility. J Urol 180:577. doi:10.1016/j.juro.2008.04.032
Laguna M, Klepp O, Horwich A et al (2004) Guidelines on testicular cancer. European Association of Urology (EAV), Arnhem, The Netherlands
Walsh TJ, Croughan MS, Schembri M et al (2009) Increased risk of testicular germ cell cancer among infertile men. Arch Intern Med 169:351. doi:10.1001/archinternmed.2008.562
Travis LB, Fossa SD, Schonfeld SJ et al (2005) Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 97:1354
Mead GM, Stenning SP (1997) The International Germ Cell Consensus Classification: a new prognostic factor-based staging classification for metastatic germ cell tumours. Clin Oncol (R Coll Radiol) 9:207. doi:10.1016/S0936-6555(97)80001-5
Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 53:478. doi:10.1016/j.eururo.2007.12.024
Hoffman KE, Chen MH, Punglia RS et al (2008) Influence of year of diagnosis, patient age, and sociodemographic status on recommending adjuvant radiation treatment for stage I testicular seminoma. J Clin Oncol 26:3937. doi:10.1200/JCO.2008.16.5043
Warde P, Specht L, Horwich A et al (2002) Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol 20:4448. doi:10.1200/JCO.2002.01.038
Krege S, Beyer J, Souchon R et al (2008) European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus Group (EGCCCG): part II. Eur Urol 53:497. doi:10.1016/j.eururo.2007.12.025
National Comprehensive Cancer Network (2009) The NCCN testicular cancer clinical practice guidelines in oncology, vol. 1. http://www.nccn.org, version 2
Berkmen F, Hizli F (2006) Stage I testicular seminoma: surveillance versus adjuvant radiotherapy. Turk J Cancer 36:169
Rudberg L, Carlsson M, Nilsson S et al (2002) Self-perceived physical, psychologic, and general symptoms in survivors of testicular cancer 3 to 13 years after treatment. Cancer Nurs 25:187. doi:10.1097/00002820-200206000-00003
Fossa SD, Abyholm T, Normann N et al (1986) Post-treatment fertility in patients with testicular cancer. III. Influence of radiotherapy in seminoma patients. Br J Urol 58:315. doi:10.1111/j.1464-410X.1986.tb09062.x
Fosså SD, Horwich A, Russell JM et al (1999) Optimal planning target volume for stage I testicular seminoma: a medical research council randomized trial. J Clin Oncol 17:1146
Joos H, Sedlmayer F, Gomahr A et al (1997) Endocrine profiles after radiotherapy in stage I seminoma: impact of two different radiation treatment modalities. Radiother Oncol 43:159. doi:10.1016/S0167-8140(97)00052-2
Albers P, Albrecht W, Algaba F et al (2008) Guidelines on testicular cancer. European Association of Urology (EAU), Arnhem, p 54
Jewett MA, Zuniga A (2008) Renal tumor natural history: the rationale and role for active surveillance. Urol Clin North Am 35:627. doi:10.1016/j.ucl.2008.07.004
Klotz L (2008) Active surveillance for prostate cancer: trials and tribulations. World J Urol 26:437. doi:10.1007/s00345-008-0330-8
Aparicio J, Germa JR, Del Muro XG et al (2005) Risk-adapted management for patients with clinical stage I seminoma: the second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol 23:8717. doi:10.1200/JCO.2005.01.9810
Loehrer PJ Sr, Bosl GJ (2005) Carboplatin for stage I seminoma and the sword of Damocles. J Clin Oncol 23:8566. doi:10.1200/JCO.2005.03.0361
Rochester M, Scurrell S, Parry JR (2008) Prospective evaluation of a novel one-stop testicular clinic. Ann R Coll Surg Engl 90:565. doi:10.1308/003588408X301055
Bosl GL, Bajorin DF, Sheinfeld J et al (2000) Cancer of the testis. In: Devita VT, Hellman S, Rosenberg SA (eds) Cancer: principles and practice of oncology. Williams and Wilkins, Lippincott, p 1269
Chung P, Parker C, Panzarella T et al (2002) Surveillance in stage I testicular seminoma—risk of late relapse. Can J Urol 9:1637
Gurkaynak M, Akyol F, Zorlu F et al (2003) Stage I testicular seminoma: para-aortic and iliac irradiation with reduced dose after orchiectomy. Urol Int 71:385. doi:10.1159/000074091
Garcia-Serra AM, Zlotecki RA, Morris CG et al (2005) Long-term results of radiotherapy for early-stage testicular seminoma. Am J Clin Oncol Cancer Clin Trials 28:119
Huddart RA, Norman A, Shahidi M et al (2003) Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol 21:1513. doi:10.1200/JCO.2003.04.173
Zagars GK, Ballo MT, Lee AK et al (2004) Mortality after cure of testicular seminoma. J Clin Oncol 22:640. doi:10.1200/JCO.2004.05.205
Van Den Belt-Dusebout AW, Nuver J, De Wit R et al (2006) Long-term risk of cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol 24:467. doi:10.1200/JCO.2005.02.7193
Horwich A (1994) Mortality and cancer incidence following radiotherapy for seminoma of the testis. Radiother Oncol 30:193. doi:10.1016/0167-8140(94)90457-X
Oliver RTD, Mason MD, Mead GM et al (2005) Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet 366:293. doi:10.1016/S0140-6736(05)66984-X
Travis LB, Curtis RE, Storm H et al (1997) Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst 89:1429. doi:10.1093/jnci/89.19.1429
Bokemeyer C, Schmoll HJ (1993) Secondary neoplasms following treatment of malignant germ cell tumors. J Clin Oncol 11:1703
Travis LB, Fosså SD, Schonfeld SJ et al (2005) Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst 97:1354
Van Leeuwen FE, Stiggelbout AM, Van den Belt-Dusebout AW et al (1993) Second cancer risk following testicular cancer: a follow-up study of 1,909 patients. J Clin Oncol 11:415
Wanderas EH, Fossa SD, Tretli S (1997) Risk of subsequent non-germ cell cancer after treatment of germ cell cancer in 2006 Norwegian male patients. Eur J Cancer, Pt A 33:253. doi:10.1016/S0959-8049(96)00458-3
Jones WG, Fossa SD, Mead GM et al (2005) Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 23:1200. doi:10.1200/JCO.2005.08.003
Yeoh E, Razali M, O’Brien PC (1993) Radiation therapy for early stage seminoma of the testis. Analysis of survival and gastrointestinal toxicity in patients treated with modern megavoltage techniques over 10 years. Australas Radiol 37:367. doi:10.1111/j.1440-1673.1993.tb00097.x
Schmoll HJ, Souchon R, Krege S et al (2004) European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 15:1377. doi:10.1093/annonc/mdh301
Schmoll HJ, Souchon R, Krege S et al (2004) European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 15:1377. doi:10.1093/annonc/mdh301
Feldman DR, Bosl GJ (2008) Treatment of stage I seminoma: is it time to change your practice? J Hematol Oncol 1:22. doi:10.1186/1756-8722-1-22
Dieckmann KP, Brüggeboes B, Pichlmeier U et al (2000) Adjuvant treatment of clinical stage I seminoma: is a single course of carboplatin sufficient? Urology 55:102. doi:10.1016/S0090-4295(99)00376-3
Oliver RTD, Edmonds PM, Ong JYH et al (1994) Pilot studies of 2 and 1 course carboplatin as adjuvant for stage I seminoma: should it be tested in a randomized trial against radiotherapy? Int J Radiat Oncol Biol Phys 29:3
Fosså SD, Gilbert E, Dores GM et al (2007) Noncancer causes of death in survivors of testicular cancer. J Natl Cancer Inst 99:533. doi:10.1093/jnci/djk111
Loehrer PJ Sr, Bosl GJ (2005) Carboplatin for stage I seminoma and the sword of damocles. J Clin Oncol 23:8566. doi:10.1200/JCO.2005.03.0361
Martin JM, Panzarella T, Zwahlen DB et al (2007) Evidence-based guidelines for following stage 1 seminoma. Cancer 109:2248. doi:10.1002/cncr.22674
Meinardi MT, Gietema JA, Van Der Graaf WTA et al (2000) Cardiovascular morbidity in long-term survivors of metastatic testicular cancer. J Clin Oncol 18:1725
Travis LB, Andersson M, Gospodarowicz M et al (2000) Treatment-associated leukemia following testicular cancer. J Natl Cancer Inst 92:1165. doi:10.1093/jnci/92.14.1165
Powles T, Robinson D, Shamash J et al (2008) The long-term risks of adjuvant carboplatin treatment for stage I seminoma of the testis. Ann Oncol 19:443. doi:10.1093/annonc/mdm540
Warde P, Gospodarowicz MK, Panzarella T et al (2000) Long term outcome and cost in the management of stage I testicular seminoma. Can J Urol 7:967
Rustin GJ, Mead GM, Stenning SP et al (2007) Randomized trial of two or five computed tomography scans in the surveillance of patients with stage I nonseminomatous germ cell tumors of the testis: medical research council trial TE08, ISRCTN56475197—The National Cancer Research Institute Testis Cancer Clinical Studies Group. J Clin Oncol 25:1310. doi:10.1200/JCO.2006.08.4889
Choo R, Thomas G, Woo T et al (2005) Long-term outcome of postorchiectomy surveillance for Stage I testicular seminoma. Int J Radiat Oncol Biol Phys 61:736
Bauduceau O, Souleau B, Le-Moulec S et al (2003) Radiotherapy in stage I testicular seminoma: retrospective study and review of literature. Cancer Radiother 7:386
Daugaard G, Petersen PM, Rørth M et al (2003) Surveillance in stage I testicular cancer. APMIS 111:76
Parker C, Milosevic M, Panzarella T et al (2002) The prognostic significance of the tumour infiltrating lymphocyte count in stage I testicular seminoma managed by surveillance. Eur J Cancer 38:2014
Aparicio J, García del Muro X, Maroto P et al (2003) Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol 14:867
Porcaro AB, Antoniolli SZ, Schiavone D et al (2002) Management of clinical stage I testicular pure seminoma. Report on 42 patients and review of the literature. Arch Ital Urol Androl 74:77
Francis R, Bower M, Brunström G et al (2000) Surveillance for stage I testicular germ cell tumours: results and cost benefit analysis of management options. Eur J Cancer 36:1925
Jones A, Fergus JN, Chapman J et al (1999) Is surveillance for stage 1 germ cell tumours of the testis appropriate outside a specialist centre? BJU Int 84:79
Coleman JM, Coleman RE, Turner AR et al (1998) The management and clinical course of testicular seminoma: 15 years' experience at a single institution. Clin Oncol (R Coll Radiol) 10:237
Germa Lluch JR, Climent MA, Villavicencio H et al (1993) Treatment of stage I testicular tumours. Br J Urol 71:473
Von Der Maase H, Specht L, Jacobsen GK et al (1993) Surveillance following orchidectomy for stage I seminoma of the testis. Eur J Cancer Part A: General Topics 29:1931
Thomas GM (1993) Surveillance in stage I seminoma of the testis. Urol Clin North Am 20:85
Ramakrishnan S, Champion AE, Dorreen MS et al (1992) Stage I seminoma of the testis: is post-orchidectomy surveillance a safe alternative to routine postoperative radiotherapy? Clin Oncol (R Coll Radiol) 4:284
Horwich A, Alsanjari N, Hern RA et al (1992) Surveillance following orchidectomy for stage I testicular seminoma. Br J Cancer 65:775
Allhoff EP, Liedke S, De Riese W et al (1991) Stage I seminoma of the testis. Adjuvant radiotherapy or surveillance? Br J Urol 68:190
Duchesne GM, Horwich A, Dearnaley DP et al (1990) Orchidectomy alone for stage I seminoma of the testis. Cancer 65:1115
Charig MJ, Hindley AC, Lloyd K et al (1990) 'Watch policy' in patients with suspected stage I testicular seminoma: CT as a sole staging and surveillance technique. Clin Radiol 42:40
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Lawrentschuk, N., Fleshner, N. Clinical stage I seminoma: the case for surveillance. World J Urol 27, 433–439 (2009). https://doi.org/10.1007/s00345-009-0430-0
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DOI: https://doi.org/10.1007/s00345-009-0430-0