Characterization of relapse in patients with clinical stage I (CSI) nonseminoma (NS-TC) managed with active surveillance (AS): A large multicenter study.

4503 Background: Large single institution trials have demonstrated that AS for patients with CSI NS-TC is safe and effective. Information on timing and extent of relapse following AS has the potential to guide intensity and duration of imaging on AS. Methods: Retrospective clinical data on CSI patients were obtained from existing large databases, including institutions/regions which have a standardized policy of centralized management of testicular cancer including AS for patients with CSI NS-TC. In all, 1,034 patients with CSI NS-TC managed with AS were reviewed of whom 886 had no lymphovascular invasion (LVI-), 220 had lymphovascular invasion (LVI+) and 28 had unknown lymphovascular status (LVI unknown). Results: A total of 221 relapses occurred with 150/886 (17%) of LVI– pts , 60/120 (50%) LVI+ pts and 11/28 (39%) of LVI unknown pts (Table). Median follow-up was 63 months (1-163 months). At last follow up 1,013/1,034 (98%) were alive without disease, 16/1,034 (1.5%) were dead of other causes and 7/1,035 (0.05%) were alive with disease or dead of disease. Relapse was identified by marker elevation and/or abdominal imaging in almost all patients. Few patients relapsed with IGCCCC intermediate (18/221, 8%) or poor risk disease (3/221, 1.4%). Conclusions: AS for CSI NS-TC is safe and effective, using a policy of centralized management with loco-regional delivery of care. Our multinational outcomes compare well to single institutional reports. Relapse other than with IGCCC good risk disease was uncommon and death from disease was rare. Compared to patients with LVI-, relapses in LVI + CSI patients occur earlier and few relapses are detected past the first year of follow-up. This data may help in the design of follow up schedules tailored towards the relapse risk in CSI NS-TC AS. [Table: see text]

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A single-center study of the utility of squamous cell carcinoma antigen (SCCAg) levels in epidermoid carcinoma of the anal canal and margin (ECACM) treated with chemoradiation (CRT)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4117 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4117-4117

Author(s):

A. Swampillai ◽

M. Williams ◽

M. Osborne ◽

S. Mawdsley ◽

R. Hughes ◽

...

Keyword(s):

Clinical Stage ◽

Positive Likelihood Ratio ◽

Tumour Marker ◽

First Year ◽

Cancer Trial ◽

Microparticle Enzyme Immunoassay ◽

N Stage ◽

Neo Adjuvant Chemotherapy ◽

The Uk

4117 Background: SCCAg is a tumour marker expressed by ECACM, measured by microparticle enzyme immunoassay; normal range 0–150ng/dl. Methods: This retrospective study examined the role of SCCAg in staging and prediction of recurrence in 195 patients (pts); 76 m:119 f with ECACM treated 1997–2007. All 195 were treated with CRT- (50.4Gy in 28 fractions of 1.8 Gy with 5-fluorouracil (5-FU) + mitomycin (MMC). Radiotherapy comprised the schedule of the UK Anal cancer Trial (ACT II). Variations included 5FU and cisplat, and capecitabine. 30 had neo-adjuvant chemotherapy followed by CRT and 3 pts had planned surgery followed by CRT. Median follow up was 36 months (range 1 - 168). Median age was 61 years (range 30 -91). In 149 pts with SCCAg samples taken prior to CRT, 107 had one or more samples taken at follow up at 3 - 6 monthly intervals. Clinical stage at diagnosis- Tx (6) T1 (28), T2 (80), T3 (65), T4 (16), N0 (126), N+ (66) Nx (3). Results: Mean baseline SCCAg by cT and cN stage were: T1 93 (ng/dl), T2 300, T3 607, T4 882, N0 376, N+ 529 (correlation coeff: T: 0.47, N: 0.33, both p< 0.001). 135 patients had baseline SCCAg with a documented response on completion of CRT. The mean baseline SCCAg for pts achieving CR was 408 and non CR was 513 (p = 0.13). Sensitivity of baseline SCCAg to predict relapse was 0.56 (specificity 0.4). Sensitivity of two consecutive elevated SCC levels during the follow up period in patients who achieved a CR to predict for relapse was 0.56 and specificity 0.83. The positive likelihood ratio was 3.3 (1.8 - 6.1) and the negative was 0.53 (0.3 - 0.9). Conclusions: There is a correlation between T and N stage and baseline SCC. In follow-up, a sustained rise in SCCAg increases the odds of relapse three-fold. We recommend SCCAg measurement in the first year after CRT. [Table: see text]

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Outcomes of progression on surveillance for clinical stage I nonseminomatous germ cell tumours (NSGCT).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.377 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 377-377 ◽

Cited By ~ 1

Author(s):

Robert James Hamilton ◽

Madhur Nayan ◽

Lynn Anson-Cartwright ◽

Philippe L. Bedard ◽

Malcolm Moore ◽

...

Keyword(s):

Clinical Stage ◽

Complete Response ◽

Primary Treatment ◽

Testis Cancer ◽

First Year ◽

Retroperitoneal Lymphadenectomy ◽

Mode Of Detection ◽

Single Modality ◽

Do So

377 Background: Active surveillance (AS) is universally accepted for clinical stage (CS) IA and favoured by most centers for CSIB. Patients progressing on AS are typically treated with chemotherapy, but there is no consensus. We describe patterns and mode of detection of progression and treatment of progression in our NSGCT AS cohort. Methods: From Dec 1980 to Aug 2011, 466 CSI NSGCT patients were managed with AS and 133 (28%) had disease progression while on AS. Treatment upon progression was physician choice but based on site of progression (e.g. retroperitoneum vs. extra-retroperitoneal), size or multifocality, and markers (S0 or stable, low level S1 vs. ≥ S1). Mode of detection of progression, characteristics at progression and primary treatment of progression (chemotherapy vs. retroperitoneal lymphadenectomy (RPLND)) were explored. Multivariate logistic regression was used to explore factors associated with receipt of more than one therapy in treatment of progression after surveillance. Results: Median time to progression was 7.3 months and detected by routine imaging (47%), routine serum tumour markers (37%), or both (12%). Progression most frequently occurred in the retroperitoneum (67%). Following progression, first-line treatment was chemotherapy for 71 (53%), RPLND for 51 (38%) and 11 (8.3%) underwent other therapy. In 59%, only one modality of treatment was required: chemotherapy only in 42/71 (59%); RPLND only in 36/51 (71%). For those treated with chemotherapy, pure embryonal carcinoma in the orchiectomy pathology (OR 0.11; p=0.05) was inversely associated with requiring further therapy. For those treated with RPLND, elevated markers pre-RPLND (OR 7.31; p=0.01) was associated with requiring further therapy. Overall, a second relapse occurred in 25/133 (19%) patients. With a median follow-up of 8.2 years, there were 5 deaths from testis cancer (3.8% of AS progressors; only 1.1% of overall AS cohort). Conclusions: The majority of patients progressing on surveillance do so in the retroperitoneum and within the first year. Of those that progress, most will achieve complete response with single modality treatment. In particular, RPLND can be utilized as monotherapy in select cases.

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Quality of Surveillance for Stage I Testis Cancer in the Community

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.9406 ◽

2009 ◽

Vol 27 (26) ◽

pp. 4327-4332 ◽

Cited By ~ 52

Author(s):

Hua-yin Yu ◽

Rodger A. Madison ◽

Claude M. Setodji ◽

Christopher S. Saigal

Keyword(s):

Private Insurance ◽

Clinical Stage ◽

Germ Cell Tumors ◽

Stage I ◽

Retroperitoneal Lymph Node Dissection ◽

Testis Cancer ◽

First Year ◽

Recurrence Rates

Purpose Patients with clinical stage I testicular germ cell tumors have been managed with adjuvant radiotherapy, chemotherapy, or retroperitoneal lymph node dissection (RPLND). The use of surveillance-only strategies at referral centers has yielded survival outcomes comparable to those achieved with adjuvant therapy. We evaluated compliance with follow-up protocols developed at referral centers within the community. Methods We identified patients with stage I testis cancer within a large private insurance claims database and calculated compliance of follow-up test use with guidelines from the National Comprehensive Cancer Network. Results Surveillance was widely used in the community. Compliance with surveillance and postadjuvant therapy follow-up testing was poor and degraded with increasing time from diagnosis. Nearly 30% of all surveillance patients received no abdominal imaging, chest imaging, or tumor marker tests within the first year of diagnosis. Patients who elected RPLND were most compliant with recommended follow-up testing within the first year. Recurrence rates were consistent with previously reported literature, despite poor compliance. Conclusion Surveillance is a widely accepted strategy in clinical stage I testicular cancer treatment in the community. However, follow-up care recommendations developed at referral centers are not being adhered to in the community. Although recurrence rates are similar to those of reported literature, the clinical impact of noncompliance on recurrence severity and mortality are not known. Further prospective work needs to be done to evaluate this apparent quality of care problem in the community.

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One course of adjuvant BEP in clinical stage I, nonseminoma: Mature and expanded results from the SWENOTECA group.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4553 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4553-4553 ◽

Cited By ~ 1

Author(s):

Torgrim Tandstad ◽

Eva Cavallin-Stahl ◽

Olav Dahl ◽

Hege Sagstuen Haugnes ◽

Carl Wilhelm Langberg ◽

...

Keyword(s):

Lymphovascular Invasion ◽

Clinical Stage ◽

Survival Rates ◽

Chemotherapy Resistance ◽

Management Program ◽

Stage I ◽

Community Based ◽

Initial Results ◽

Disease Specific

4553 Background: The SWENOTECA group has since 1998 offered patients with clinical stage I (CSI) nonseminoma (NSGCT) treatment based on a risk-adapted approach. Patients with lymphovascular invasion (VASC+) were recommended one course of adjuvant chemotherapy (ACT) with bleomycin, etoposide and cisplatin (BEP). Patients without lymphovascular invasion (VASC-) had the choice between one course of adjuvant BEP or active surveillance. Methods: From 1998-2010, 491 patients with CSI NSGCT received one course of adjuvant BEP. Following histopathological evaluation 247 patients were classified as VASC+, 239 as VASC- and five patients had uncertain VASC status. All patients were included into a prospective, community-based, multicenter SWENOTECA management program. Initial results from patients treated during 1998-2005 have earlier been reported. We now report the mature data, expanded with patients treated during 2005-2010. Results: The median follow-up was 8.0 years. Eleven relapses were observed. After one course of adjuvant BEP 2.3% of patients relapsed. In regard to VASC status 3.4% of VASC+ and 1.3% of VASC- patients relapsed. The latest relapse was detected 3.3 years after ACT. Ten patients have died, only one due to testicular cancer. The 5 and 10-year overall survival rates were 98.9% and 96.8%, respectively. The 5 and 10-year disease-specific survival rates were 100% and 99.6% respectively. Conclusions: One course of adjuvant BEP reduces the risk of relapse in CSI NSGCT with over 90%. These mature results confirm our earlier results on one course of adjuvant BEP. There is no evidence of late relapses, or chemotherapy-resistance in relapses following ACT. To detect relapses, a follow-up of five years is sufficient.

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Nonguideline concordant treatment of testicular cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.407 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 407-407

Author(s):

Pia Paffenholz ◽

David Pfister ◽

Axel Heidenreich

Keyword(s):

Testicular Cancer ◽

Retrospective Analysis ◽

Therapeutic Approach ◽

Clinical Stage ◽

Primary Therapy ◽

Inappropriate Therapy ◽

Common Error ◽

Inappropriate Treatment ◽

Almost All

407 Background: The management of testicular cancer requires a complex multimodal therapeutic approach. Despite the availability of regularly updated national and international guidelines on testicular cancer, treatment still differs between the institutions probably affecting the patients’ outcome. Our study aims to investigate frequently occurring errors regarding the diagnosis and therapy of testicular cancer in consideration of the current EAU guidelines. Methods: We performed a retrospective analysis including 129 patients diagnosed with testicular cancer that were referred to our department between 09/2015 and 10/2016. Patients’ age, histology, clinical stage, IGCCCG risk classification, treatment (surveillance, chemotherapy, radiotherapy, surgery) and follow-up were investigated and compared to the EAU guidelines’ recommendations. Results: Of the eligible 129 patients, 34 (26%) patients displayed a non-guideline concordant care. The most common error was undertreatment (47%), mostly due to missing chemotherapy cycles. Modified treatment and overtreatment occurred in 20% and 16% respectively, while inappropriate treatment (9%) and misdiagnosis (6%) were rarely seen. In secondary treated patients, non-guideline concordant therapy was observed more frequently compared to those patients receiving primary therapy (59% vs. 41 %). Almost all patients (93%) receiving a non-guideline concordant therapy suffered a relapse in contrast to 67% of patients that were treated according to the EAU guidelines. Conclusions: Non-adherence to the current EAU guidelines on testicular cancer appears to be a major problem in various testicular cancer treating institutions. In our study, the most frequent error was undertreatment, followed by modified treatment and overtreatment. Inappropriate therapy leads to a higher relapse rate and morbidity associated with a worse curative outcome.

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Prospective study of pain and psychological symptoms of first-year university students

Journal of Novel Physiotherapy and Rehabilitation ◽

10.29328/journal.jnpr.1001038 ◽

2021 ◽

Vol 5 (1) ◽

pp. 001-004

Author(s):

Oksanen Airi ◽

Laimi Katri ◽

Löyttyniemi Eliisa ◽

Kunttu Kristina

Keyword(s):

University Students ◽

Cohort Studies ◽

Prospective Study ◽

Psychological Symptoms ◽

The Other ◽

First Year ◽

First Year Students ◽

Almost All ◽

First Year University

Background: Even if pain and psychological symptoms experienced by university students are common, the prognosis of these symptoms is unknown. Objective: To examine the incidence and the outcome of frequent musculoskeletal and psychological symptoms in a 4-year follow-up of first-year university students. Methods: In 2008, a national random sample (N=2750) of Finnish university students completed a questionnaire concerning pain and psychological symptoms. Of the 416 first-year students, 123 responded to the same questionnaire also in their fourth study year in 2012. Results: Of the first-year university students with frequent pain or psychological symptoms, one half (47% - 65%) reported frequent symptoms also four years later. Almost all (78% – 95%) of the symptom-free first-year students were symptom-free also in their fourth study year. Conclusion: Our findings indicate that pain and psychological symptoms in university students are rather persistent during the first four study years. On the other hand, as half of those with frequent symptoms become symptomless and as the prognosis of symptom-free students is favourable, there is still need for further cohort studies on this issue.

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Klinische Langzeitergebnisse der perkutanen transluminalen Angioplastie bei Patienten mit peripherer arterieller Verschlusskrankheit

VASA ◽

10.1024/0301-1526.31.1.36 ◽

2002 ◽

Vol 31 (1) ◽

pp. 36-42 ◽

Cited By ~ 3

Author(s):

. Bucek ◽

Hudak ◽

Schnürer ◽

Ahmadi ◽

Wolfram ◽

...

Keyword(s):

Success Rate ◽

Clinical Stage ◽

Ankle Brachial Index ◽

Clinical Situation ◽

Clinical Results ◽

Transluminal Angioplasty ◽

Term Outcome ◽

Long Term Outcome

Background: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. Patients and methods: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. Results: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0,001), the same results were observed at the end of follow-up (each P < 0,001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0,017) and lower ABI pre-interventional (P = 0,019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. Conclusion: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.

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