No longer any role for routine follow-up chest x-rays in men with stage I germ cell cancer

PURPOSE This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 years after completion of treatment. PATIENTS AND METHODS A review of all patients treated at Indiana University Medical Center from 1979 through 1992 for late relapse was conducted. Eighty-one patients were treated for late relapse of testicular cancer. Forty-seven patients relapsed more than 5 years after successful management of their initial disease. RESULTS At initial diagnosis, 35 patients had clinical stage I, 18 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherapy before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (25.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their therapy. Of sixty-five patients treated for late relapse by chemotherapy, 17 (26.2%) had a complete response, but only two have been continuously disease-free with chemotherapy alone. These two never received prior chemotherapy. CONCLUSION Late relapse of testis cancer is more common than previously thought. Surgery is the preferred mode of therapy. Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse.

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Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033713 ◽

2019 ◽

Vol 9 (10) ◽

pp. e033713 ◽

Cited By ~ 2

Author(s):

Thomas Wagner ◽

Birgitte Grønkær Toft ◽

Birte Engvad ◽

Jakob Lauritsen ◽

Michael Kreiberg ◽

...

Keyword(s):

Risk Factors ◽

Testicular Cancer ◽

Germ Cell ◽

Clinical Stage ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I ◽

Testicular Germ Cell ◽

Testicular Germ Cell Cancer

IntroductionApproximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease.Methods and analysisAll incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model.Ethics and disseminationThis study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.

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646 The impact of different follow-up strategies on mortality in clinical stage I non-seminomatous germ cell cancer. A semi-Markov simulation study

European Urology Supplements ◽

10.1016/s1569-9056(04)90641-0 ◽

2004 ◽

Vol 3 (2) ◽

pp. 164

Author(s):

J.R. Spermon ◽

A.L. Hoffmann ◽

A.L.M. Verbeek ◽

J.A. Witjes ◽

L.A.L.M. Kiemeney

Keyword(s):

Germ Cell ◽

Simulation Study ◽

Clinical Stage ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I ◽

The Impact

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The Efficacy of Different Follow-Up Strategies in Clinical Stage I Non-Seminomatous Germ Cell Cancer: A Markov Simulation Study

European Urology ◽

10.1016/j.eururo.2005.04.021 ◽

2005 ◽

Vol 48 (2) ◽

pp. 258-268 ◽

Cited By ~ 6

Author(s):

Jesse Roan Spermon ◽

Aswin L. Hoffmann ◽

Simon Horenblas ◽

Andre L.M. Verbeek ◽

J. Alfred Witjes ◽

...

Keyword(s):

Germ Cell ◽

Simulation Study ◽

Clinical Stage ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I

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Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: a trial of the Gynecologic Oncology Group.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.4.701 ◽

1994 ◽

Vol 12 (4) ◽

pp. 701-706 ◽

Cited By ~ 224

Author(s):

S Williams ◽

J A Blessing ◽

S Y Liao ◽

H Ball ◽

P Hanjani

Keyword(s):

Germ Cell ◽

Gynecologic Oncology ◽

Cell Cancer ◽

Germ Cell Tumors ◽

Germ Cell Cancer ◽

Gynecologic Oncology Group ◽

Long Term Follow Up ◽

Acute Myelomonocytic Leukemia

PURPOSE This study was performed to determine the effectiveness of postoperative adjuvant chemotherapy in patients with surgically resected ovarian germ cell tumors. PATIENTS AND METHODS After tumor removal and thorough surgical staging, patients were enrolled on this study and treated with three courses of cisplatin, etoposide, and bleomycin (BEP). Reassessment laparotomy was required of consenting, appropriate patients initially, but became an optional procedure in 1989. RESULTS Of 93 patients assessable on this trial, 89 are continuously free of germ cell cancer. At second-look laparotomy, two other patients were found to have small foci of immature teratoma; both remain clinically free of recurrence. One received subsequent alternate chemotherapy and one did not. Thus, 91 of 93 patients are currently free of germ cell cancer. Follow-up duration ranges from 4.0 to 90.3 months, with 67 patients monitored for longer than 2 years. Acute toxicity was moderate. One patient developed acute myelomonocytic leukemia 22 months after diagnosis. Another patient was noted to have a malignant lymphoma 69 months after protocol treatment. CONCLUSION Three courses of BEP will nearly always prevent recurrence in well-staged patients with completely resected ovarian germ cell tumors and should be given to all such patients. The development of acute leukemia as a complication of treatment is disturbing and mandates careful long-term follow-up, but is unusual and does not alter the risk-to-benefit ratio of treatment.

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