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Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer

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Abstract

Background

Cancer-specific survival for patients with clinical stage I (CSI) germ cell testicular cancer (GCTC) is outstanding after inguinal orchidectomy regardless the treatment utilized. This study evaluated whether active surveillance (AS) of such patients yielded similar health outcomes to other therapeutic strategies such as adjuvant chemotherapy, radiotherapy or primary retroperitoneal lymphadenectomy as described in the literature.

Patients and methods

Patients with CSI GCTC were screened between January 2012 and December 2016. Patients had previously undergone inguinal orchidectomy as the primary treatment and chosen AS as their preferred management strategy after receiving information about all available strategies.

Results

Out of 91 patients screened, 82 patients selected AS as their preferred management strategy. Relapse rate in the overall population was 20% (95% CI 12–30) and median time to relapse was 11.5 months (range 1.0–35.0). In patients with seminomatous tumors, relapse rate decreased to 13% and median time to relapse was 13 months; whereas in patients with non-seminomatous tumors, relapse rate was 33% (IA) or 29% (IB) and median time to relapse was 12 months in stage IA and 4.5 months in stage IB patients. All relapses were rescued with three or four cycles of chemotherapy and two also required a retroperitoneal lymphadenectomy. All patients are currently alive and free of disease.

Conclusions

The clinical outcomes of patients with CSI GCTC managed by AS in this series were excellent. This strategy limited the administration of active treatments specifically to the minority of patients who relapsed without compromising performance.

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References

  1. Bray F, Richiardi L, Ekbom A, Pukkala E, Cuninkova M, Moller H. Trends in testicular cancer incidence and mortality in 22 European countries: continuing increases in incidence and declines in mortality. Int J Cancer. 2006;118:3099–111.

    Article  CAS  PubMed  Google Scholar 

  2. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C et al, GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC CancerBase No. 11. International Agency for Research on Cancer, Lyon, France. 2013. Available from http://globocan.iarc.fr. Accessed March 2018.

  3. Rajpert-De Meyts E. Developmental model for the pathogenesis of testicular carcinoma in situ: genetic and environmental aspects. Hum Reprod Update. 2006;12:303–23.

    Article  Google Scholar 

  4. Kollmannsberger C, Tandstad T, Bedard PL, Cohn-Cedermark G, Chung PW, Jewett MA, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33:51–7.

    Article  PubMed  Google Scholar 

  5. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366:293–300.

    Article  CAS  PubMed  Google Scholar 

  6. Daugaard G, Gundgaard MG, Mortensen MS, Agerbaek M, Holm NV, Rorth M, et al. Surveillance for stage I nonseminoma testicular cancer: outcomes and long-term follow-up in a population-based cohort. J Clin Oncol. 2014;32:3817–23.

    Article  PubMed  Google Scholar 

  7. Leung E, Warde P, Jewett M, Panzarella T, O’Malley M, Sweet J, et al. Treatment burden in stage I seminoma: a comparison of surveillance and adjuvant radiation therapy. BJU Int. 2013;112:1088–95.

    Article  PubMed  Google Scholar 

  8. Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, et al. Guidelines on testicular cancer: 2015 update. Eur Urol. 2015;68:1054–68.

    Article  PubMed  Google Scholar 

  9. Motzer RJ, Jonasch E, Agarwal N, Beard C, Bhayani S, Bolger GB, et al. Testicular cancer, version 2.2015. J Natl Compr Cancer Netw. 2015;13:772–99.

    Article  Google Scholar 

  10. Wood L, Kollmannsberger C, Jewett M, Chung P, Hotte S, O’Malley M, et al. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J. 2010;4:e19–38.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, et al. 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. 2008;53:478–96.

    Article  PubMed  Google Scholar 

  12. Krege S, Beyer J, Souchon R, Albers P, Albrecht W, Algaba F, et al. 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. 2008;53:497–513.

    Article  PubMed  Google Scholar 

  13. Sturgeon JF, Moore MJ, Kakiashvili DM, Duran I, Anson-Cartwright LC, Berthold DR, et al. Non-risk-adapted surveillance in clinical stage I nonseminomatous germ cell tumors: the Princess Margaret Hospital’s experience. Eur Urol. 2011;59:556–62.

    Article  PubMed  Google Scholar 

  14. Pierorazio PM, Albers P, Black PC, Tandstad T, Heidenreich A, Nicolai N, et al. Non-risk-adapted surveillance for stage I testicular cancer: critical review and summary. Eur Urol. 2018;73:899–907.

    Article  PubMed  Google Scholar 

  15. Aparicio J, Terrasa J, Duran I, Germa-Lluch JR, Girones R, Gonzalez-Billalabeitia E, et al. SEOM clinical guidelines for the management of germ cell testicular cancer. Clin Transl Oncol. 2016;18:1187–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Mortensen MS, Lauritsen J, Kier MG, Bandak M, Appelt AL, Agerbaek M, et al. Late relapses in stage I testicular cancer patients on surveillance. Eur Urol. 2016;70:365–71.

    Article  PubMed  Google Scholar 

  17. Nayan M, Jewett MA, Hosni A, Anson-Cartwright L, Bedard PL, Moore M, et al. Conditional risk of relapse in surveillance for clinical stage I testicular cancer. Eur Urol. 2017;71:120–7.

    Article  PubMed  Google Scholar 

  18. Oldenburg J, Wahlqvist R, Fossa SD. Late relapse of germ cell tumors. World J Urol. 2009;27:493–500.

    Article  PubMed  Google Scholar 

  19. Sharp DS, Carver BS, Eggener SE, Kondagunta GV, Motzer RJ, Bosl GJ, et al. Clinical outcome and predictors of survival in late relapse of germ cell tumor. J Clin Oncol. 2008;26:5524–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sheinfeld J, Feldman DR. Editorial comment. Urology. 2014;84:890–1.

    Article  PubMed  Google Scholar 

  21. Aparicio J, Garcia del Muro X, Maroto P, Paz-Ares L, Alba E, Saenz A, et al. Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol. 2003;14:867–72.

    Article  CAS  PubMed  Google Scholar 

  22. Choo R, Thomas G, Woo T, Lee D, Kong B, Iscoe N, et al. Long-term outcome of postorchiectomy surveillance for stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2005;61:736–40.

    Article  PubMed  Google Scholar 

  23. Rustin GJ, Mead GM, Stenning SP, Vasey PA, Aass N, Huddart RA, et al. 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. 2007;25:1310–5.

    Article  PubMed  Google Scholar 

  24. Chung PWM, O’Malley M, Jewett MAS, Panzarella T, Hogg D, Moore MJ, et al. Evaluation of low-dose CT scans for surveillance in stage I testicular cancer. J Clin Oncol. 2011;29:4565-.

    Article  Google Scholar 

  25. Tandstad T, Dahl O, Cohn-Cedermark G, Cavallin-Stahl E, Stierner U, Solberg A, et al. Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: the SWENOTECA management program. J Clin Oncol. 2009;27:2122–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the assistance of Dr. Beatriz Gil-Alberdi from HealthCo (Madrid, Spain) for her help in preparing the first draft of this manuscript. Medical writing services were supported financially by FISEVI (The Andalusian Public Foundation for the Management of Health Research in Seville, Spain).

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Authors and Affiliations

  1. Medical Oncology Department, Virgen del Rocío University Hospital, Seville, Spain

    R. Escudero-Ávila, J. D. Rodríguez-Castaño, F. Fernandez, P. Sancho, B. Perez-Valderrama & I. Duran

  2. Urology Department, Virgen del Rocío University Hospital, Seville, Spain

    I. Osman & R. Medina

  3. Pathology Department, Virgen del Rocío University Hospital, Seville, Spain

    M. Japón-Rodríguez

  4. Department of Statistics, FISEVI, Virgen del Rocío University Hospital, Seville, Spain

    J. M. Praena-Fernández

  5. Institute of Biomedicine of Seville (IBIS), CSIC, University of Seville, Seville, Spain

    I. Duran

  6. Medical Oncology Department, Hospital Universitario Marques de Valdecilla, Avda. Valdecilla s/n, 39008, Santander, Spain

    I. Duran

  7. Radiology Department, Virgen del Rocío University Hospital, Seville, Spain

    B. Vargas

Authors
  1. R. Escudero-Ávila
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  2. J. D. Rodríguez-Castaño
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  5. R. Medina
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  7. M. Japón-Rodríguez
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  9. B. Perez-Valderrama
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  11. I. Duran
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Corresponding author

Correspondence to I. Duran.

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Conflict of interest

The authors have stated that they do not have any conflict of interest that may inappropriately influence this work.

Ethical approval

The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed consent was obtained from all individual participants of this study.

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Escudero-Ávila, R., Rodríguez-Castaño, J.D., Osman, I. et al. Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer. Clin Transl Oncol 21, 796–804 (2019). https://doi.org/10.1007/s12094-018-1990-5

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  • DOI: https://doi.org/10.1007/s12094-018-1990-5

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