Excellent outcomes in bilateral testicular germ cell tumors over four decades.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 523-523
Author(s):  
Ning-Ning Lu ◽  
Aaron Richard Hansen ◽  
Philippe L. Bedard ◽  
Padraig Richard Warde ◽  
Joan Sweet ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Patient Characteristics ◽  
Stage I ◽  
Second Primary ◽  
Time Interval ◽  
Testicular Germ Cell ◽  
Prior Therapy

523 Background: Bilateral testicular germ cell tumours (BTC) form a small minority of testicular cancer and detailed management data are sparse. Methods: Bilateral testicular cancer (BTC) patients managed at a single cancer centre were retrospectively analyzed. Synchronous BTC was defined as uni+contralateral presentation within 3 months. Patient characteristics, treatment and outcomes were collected. Kaplan-Meier method was used to calculate the overall survival (OS) and relapse-free survival (RFS). Results: Between Jan 1971 to Jun 2018, 118 pts were included. Nine patients (7.6%) had cryptorchidism. Twenty-two patients (18.6%) had synchronous BTC at median age of 30(21-54) years, 11 presented with concordant histology (10-seminoma). Median follow-up time was 96(1-220) months. Two of 14 patients (14%) with stage I disease on surveillance had retroperitoneal nodal recurrence, other 3 (21%) had testicular recurrence after partial orchiectomy alone. No recurrence occurred for 8 stage II/III patients (36%) who received stage-appropriate treatment. All patients were alive without disease at last follow-up. For metachronous BTC, the median age was 27(16-68) and 37(19-78) years for first and second diagnosis, respectively. The median time interval was 88 (8-352) months, with shorter interval when second primary was non-seminoma, median 69 vs. 92 months. Concordant histology was present in 58 (38-seminoma) patients and discordant in 38 patients. There were 66, 23, 7 and 84, 9, 3 patients with stage I, II, III disease for first and second testicular cancer (TC), respectively. For all stage I disease, 69% of non-seminoma (n = 33) and 79% of seminoma (n = 81) were on surveillance, of whom the crude relapse rate was 15%. The median follow-up time after second diagnosis was 87 months. In all, 35 patients (30%) with recurrence except 1 were successfully salvaged. The 10-year OS and RFS for whole cohort was 99% and 69.8%, respectively. Conclusions: In our series, seminoma was the more common pathology, and management based on pathology and stage yielded excellent outcomes regardless of prior therapy. Metachronous BTC may occur at extremely long time intervals such that longer follow-up is needed to capture the majority of contralateral primary TC.

Importance of a new tumor market TRA-1-60 in the follow-up of patients with clinical stage I nonseminomatous testicular germ cell tumors

1997 ◽  
Vol 4 (4) ◽  
pp. 321-327 ◽  
Author(s):  
Mariël E. Gels ◽  
Jan Marrink ◽  
Petra Visser ◽  
Dirk Th. Sleijfer ◽  
Jos H. J. Droste ◽  
...  
Keyword(s):  
Germ Cell ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell

Late relapse of testicular cancer.

1995 ◽  
Vol 13 (5) ◽  
pp. 1170-1176 ◽  
Author(s):  
J Baniel ◽  
R S Foster ◽  
R Gonin ◽  
J E Messemer ◽  
J P Donohue ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Cell Cancer ◽  
Germ Cell Cancer ◽  
Stage I ◽  
Late Relapse ◽  
Testicular Germ Cell ◽  
Testicular Germ Cell Cancer ◽  
Disease Free

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.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e033713 ◽  
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.

Detection of recurrence in patients with clinical stage I nonseminomatous testicular germ cell tumors and consequences for further follow-up: a single-center 10-year experience.

1995 ◽  
Vol 13 (5) ◽  
pp. 1188-1194 ◽  
Author(s):  
M E Gels ◽  
H J Hoekstra ◽  
D T Sleijfer ◽  
J Marrink ◽  
H W de Bruijn ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Vascular Invasion ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Ct Scans ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Wait And See

PURPOSE A wait-and-see policy for patients with stage I nonseminomatous testicular germ cell tumors (NSTGCT) was evaluated in a prospective study. The frequency and time of recurrence, detection of recurrence, and presence of unfavorable prognostic factors were investigated. PATIENTS AND METHODS During the period 1982 to 1992, 154 patients with stage I NSTGCT (median age, 29 years) underwent orchidectomy and were monitored at follow-up evaluation with physical examinations, alfafetoprotein (AFP) and beta-human choriogonadotropin (hCG) levels, chest x-rays (CXR), and computed tomographic (CT) scans of the abdomen and chest. Multivariate logistic regression analyses were performed to identify prognostic factors. RESULTS During a median follow-up period of 7 years (range, 2 to 12), recurrence was found in 42 patients (27.3%). All cases of recurrence were detected within 2 years, 90% in the first year after orchidectomy. In 29 patients (69.0%), recurrence was detected in the abdominal lymph nodes. Nine patients (21.4%) had metastases in the retroperitoneum and mediastinum and/or lungs, and four patients (9.6%) had metastases only in the mediastinum or lungs. The majority of recurrences (97.6%) were detected by tumor markers and CT scans. Recurrence was related to the presence of vascular invasion, embryonal carcinoma (E), elevated preoperative hCG level, and absence of mature teratoma (M). Only vascular invasion was an independent risk factor. After polychemotherapy treatment for recurrence, the survival rate for the total group was 98.7%. CONCLUSION The wait-and-see policy is a reliable method for follow-up monitoring of patients with stage I NSTGCT. Even in patients with unfavorable prognostic factors, it is justified to await the possible appearance of metastases. For the future, it is recommended that CXR be omitted from the schedule, and it might be feasible to discontinue follow-up evaluations after 5 years.

Testicular germ cell tumors and human immunodeficiency virus infection: a report of 26 cases. Italian Cooperative Group on AIDS and Tumors.

1995 ◽  
Vol 13 (11) ◽  
pp. 2705-2711 ◽  
Author(s):  
D Bernardi ◽  
R Salvioni ◽  
E Vaccher ◽  
L Repetto ◽  
N Piersantelli ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Survival Rate ◽  
Testicular Cancer ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Cooperative Group ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Immunodeficiency Virus

PURPOSE Besides tumors that are diagnostic of AIDS, such as non-Hodgkin's lymphoma, Kaposi's sarcoma, and invasive carcinoma of the cervix, other tumors have been described in the human immunodeficiency virus (HIV) setting. Some case reports on testicular cancer in HIV-infected patients have appeared in the literature. We present a retrospective study on 26 cases of testicular germ cell tumors (TGCTs) observed within the Italian Cooperative Group on AIDS and Tumors (GICAT) between November 1986 and September 1994. PATIENTS AND METHODS Twenty-six patients with TGCT and HIV-infection from the GICAT were retrospectively analyzed. RESULTS Fourteen patients had seminoma and 12 had nonseminoma. Four patients underwent only orchidectomy, one patient received only chemotherapy, nine patients were treated with postsurgical chemotherapy, 10 patients (38%) received postsurgical radiotherapy, one patient received postsurgical chemotherapy plus radiotherapy, and one patient was lost for follow-up evaluation immediately after diagnosis. The complete response (CR) rate was 95%. Relapse occurred in 32% of patients. The median follow-up time was 33 months. The mortality rate was 37%. Causes of death were neoplasia in three of nine patients, AIDS in five of nine patients, and fortuitous event in one of nine patients. The overall 3-year survival rate was 65%, and the 3-year disease-free survival rate was 65%. Severe hematologic toxicity was observed in seven of 15 patients. CONCLUSION HIV-infected patients with testicular cancer should be offered standard oncologic therapy, irrespective of their HIV status, since the majority can be cured of their tumor and have a good quality of life. Use of concomitant prophylaxis for opportunistic infections is recommended.

Prognostic factors in patients with pathological stage I non-seminomatous testicular germ cell tumors and tumor recurrence during follow-up

1995 ◽  
Vol 23 (4) ◽  
pp. 211-213 ◽  
Author(s):  
P. Albers ◽  
W. T. DeRiese ◽  
T. M. Ulbright ◽  
J. P. Donohue ◽  
R. S. Foster
Keyword(s):  
Prognostic Factors ◽  
Germ Cell ◽  
Tumor Recurrence ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Testicular Germ Cell Tumors ◽  
Pathological Stage ◽  
Testicular Germ Cell

Bilateral testicular germ cell tumors.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 392-392
Author(s):  
Stephanie A. Curreri ◽  
Sarah C. Markt ◽  
Rowan Miller ◽  
Elizabeth O'Donnell ◽  
Brandon David Bernard ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Cause Of Death ◽  
Germ Cell Tumors ◽  
Malignant Neoplasm ◽  
Patient Characteristics ◽  
Second Malignant Neoplasm ◽  
Testicular Germ Cell ◽  
Risk Of Death ◽  
Increased Risk

392 Background: Germ cell tumors (GCTs), both seminomatous and non-seminomatous, account for greater than 90% of testicular cancers. While bilateral testicular GCTs are rare, the incidence of bilateral tumors has increased over time. Methods: 668 cases of bilateral and 38,593 cases of unilateral testicular GCTs were reported between 1973 and 2011 by the SEER database. Patient characteristics and tumor features were analyzed. Results: The incidence of bilateral GCTs among men with testicular GCTs was 1.7% (668 of 39,261 total cases). Among the 668 men with bilateral GCTs, 53% (n=353) of second GCTs occurred within three years after the first cancer. 29% (n=196) of bilateral tumors occurred synchronously. Among patients with bilateral GCTs, 378 first GCTs and 466 second GCTs were seminomatous. 43% of bilateral cases were concordant seminomatous GCTs, 16% were concordant non-seminomas, and 41% were discordant histologies. 68% of unilateral GCTs, 70% of first GCTs, and 82% of second GCTs were staged as Localized disease. Testicular cancer was the cause of death for 4% (n=1,630) of men with a unilateral GCT and 1% (n=8) of men with bilateral GCTs. A second malignant neoplasm (SMN) was the cause of death for 2% (n=736) of men with a unilateral GCT and 2% (n=16) of men with bilateral GCTs. Conclusions: Among men with bilateral testicular GCTs, 59% had concordant histological diagnoses between their first and second tumor. Most (53%) second cancers among men with bilateral tumors occurred within three years after diagnosis of first cancers. Men who experience bilateral testicular GCTs do not appear to have an increased risk of death due to testicular cancer or a subsequent non-germ cell malignant neoplasm compared to men with a unilateral testicular GCT. [Table: see text]

Serum Lactate Dehydrogenase Isoenzyme 1 and Relapse in Patients with Nonseminomatous Testicular Germ Cell Tumors Clinical Stage I

2001 ◽  
Vol 40 (4) ◽  
pp. 536-540 ◽  
Author(s):  
Finn Edler von Eyben ◽  
Ebbe Lindegaard Madsen ◽  
Ole Blaabjerg ◽  
Per Hyltoft Petersen ◽  
Hans von der Maase ◽  
...  
Keyword(s):  
Lactate Dehydrogenase ◽  
Germ Cell ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Serum Lactate ◽  
Stage I ◽  
Serum Lactate Dehydrogenase ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Dehydrogenase Isoenzyme

Secondary neoplasms following treatment of malignant germ cell tumors.

1993 ◽  
Vol 11 (9) ◽  
pp. 1703-1709 ◽  
Author(s):  
C Bokemeyer ◽  
H J Schmoll
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Cumulative Incidence ◽  
Lymphoblastic Leukemia ◽  
Germ Cell Tumors ◽  
German Population ◽  
Secondary Neoplasms ◽  
Secondary Neoplasia ◽  
Malignant Germ Cell Tumors

PURPOSE The current study investigates the frequency and outcome of secondary malignancies in patients treated for testicular cancer at Hannover University Medical School between 1970 and 1990. PATIENTS AND METHODS One thousand twenty-five patients with a median follow-up duration of 61 months (range, 12 to 240) were included in the analysis. Follow-up was complete in 1,018 patients (99%). Histology was seminoma in 324 patients (38.7%) and nonseminomatous germ cell tumor in 624 patients (61.3%). At the time of median follow-up, 814 patients (79.9%) were alive. RESULTS Fourteen patients developed a secondary neoplasm (cumulative incidence, 1.38%; 95% confidence interval [CI], 0.75 to 2.30); 13 patients had solid tumors and one had secondary lymphoblastic leukemia with a t(4; 11) translocation including band 11q23. None of 224 patients on surveillance strategy (with or without retroperitoneal lymph node dissection [RPLND]) developed a second neoplasm, compared with four of 413 patients (0.97%; 95% CI, 0 to 1.9) after cisplatin-based chemotherapy (not significant) and nine of 332 patients (2.7%; 95% CI, 0.9 to 4.5) after radiotherapy (P = .02). The cumulative incidence of a secondary neoplasia of 1.76% (95% CI, 0.97 to 2.94) in patients treated by radiotherapy and/or chemotherapy was significantly higher compared with patients on surveillance protocols (P = .03). Chemotherapy containing standard-dose etoposide did not increase the risk of occurrence of secondary neoplasms. A significantly elevated relative risk of 7.53 (range, 3.4 to 14.3) compared with the male German population was only found for patients treated by radiotherapy. CONCLUSION Compared with patients who have other curable malignant tumors, an incidence of 1.38 of secondary neoplasms after a median follow-up duration of 61 months is low. The highest risk for secondary neoplasia after treatment of testicular cancer is associated with the use of radiotherapy. Following chemotherapy, no significantly elevated risk was observed. In conclusion, the benefits of curative treatment far outweigh the risk of secondary cancer in patients with malignant germ cell tumors.

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