MANAGEMENT AND OUTCOME OF STAGE I SEMINOMA IN ONTARIO.

2008 ◽  
Vol 31 (4) ◽  
pp. 2
Author(s):  
Howard H An ◽  
Paul Y Peng ◽  
William J Mackillop
Keyword(s):  
Testicular Cancer ◽  
Patient Outcomes ◽  
Management Strategies ◽  
Patient Characteristics ◽  
Population Based ◽  
Stage I ◽  
Adjuvant Radiation ◽  
Chi Squared ◽  
Stage I Seminoma ◽  
Student’S T

Purpose: To describe the uptake and use of surveillance andirradiation in stage I seminoma post-orchiectomy in Ontario and to evaluate theimpact of these management strategies on patient outcomes. Background: Testicular cancer is the most common cancer in menbetween the ages of 20 and 44 (1). About half of testicular cancers areseminomas (2). Overall 85% of seminoma patients present with stage I disease with10-year survival over 99%. Adjuvant radiation therapy once constituted thestandard of care but surveillance as a post-orchiectomy management strategy isnow preferred in Ontario (3). Treatment with radiation results in importantlong-term toxicities (2). The actual management patterns and the effect ofthese patterns on seminoma patient outcomes is unknown. This will be the firstphase IV study to describe the management of stage I seminoma and to evaluateit’s effect on patient outcomes. Methods: This is a retrospective, population based cohort studyof seminoma patients in Ontario. Cases of seminoma are identified through theOntario Cancer Registry and linked with patient data from the CanadianInstitute of Health Information and Ontario radiotherapy data. An instrumentalvariable approach will be taken with time and location of treatment as theinstruments. Mantel-Haensel Chi-Squared tests, Student’s T-test, and Log ranktests will be used to find differences in patient characteristics, morbidity andsurvival. The Kaplan-Meier method will be used to model overall survival. Results and Conclusions:Pending data analysis. References: 1. Warde P, Srugeon J,Gospodarowicz M. Testicular Cancer. In: Gunderson L, Tepper J, eds. Clinicalradiation oncology. Philadelphia: Chruchill Livingstone; 2000: 844-862. 2. Nichols CR, Hung A, Corless CL, Foster RS, Roth BJ, Einhorn LH.Testis cancer. In: Kufe DW, Frei III E, Holland JF, Weichselbaum RR, PollockRE, Bast Jr RC, Hong WK, Hait WN, eds. Holland-Frei cancer medicine – 7^thEd.[e-book], Columbia: BC Decker; 2006 [cited 2008 Mar 17]: ch. 99. Availablefrom: Stat!Ref. 3. Chung P, Mayhew LA, Warde P, Winquist E, Lukka H et al. Management of stage I seminoma: Guidelinerecommendations. Cancer Care Ontario, Evidence-Based Series #3-18: Section1; Report date: 30 Jan 2008.

scholarly journals 213P Stage I seminoma testicular cancer: Predictors of relapse and outcomes for adjuvant carboplatin vs active surveillance

2020 ◽  
Vol 31 ◽  
pp. S1323
Author(s):  
G.T. Quah ◽  
D. Espinoza ◽  
M. Crumbaker ◽  
B. Balakrishnar ◽  
M. Arasaratnam ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Active Surveillance ◽  
Stage I ◽  
Stage I Seminoma

scholarly journals Adjuvant radiation therapy in stage I seminoma: 20 years of oncologic results

Oncotarget ◽  
2016 ◽  
Vol 7 (48) ◽  
pp. 80077-80082 ◽  
Author(s):  
Francesca De Felice ◽  
Daniela Musio ◽  
Giovanni Luca Gravina ◽  
Francesco Marampon ◽  
Vincenzo Tombolini
Keyword(s):  
Radiation Therapy ◽  
Stage I ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Oncologic Results ◽  
Stage I Seminoma

Characteristics of multiple sclerosis in aboriginals living in British Columbia, Canada

2012 ◽  
Vol 18 (9) ◽  
pp. 1239-1243 ◽  
Author(s):  
Jameelah Saeedi ◽  
Peter Rieckmann ◽  
Irene Yee ◽  
Helen Tremlett ◽  
Keyword(s):  
Multiple Sclerosis ◽  
British Columbia ◽  
Clinical Characteristics ◽  
Age At Onset ◽  
Disease Onset ◽  
Patient Characteristics ◽  
Onset Date ◽  
Disease Course ◽  
Chi Squared ◽  
Student’S T

Objectives: The objectives of this study were to identify and describe the demographic and clinical characteristics of multiple sclerosis (MS) in aboriginals in British Columbia (BC), Canada and compare these findings with non-aboriginal MS patients. Methods: This retrospective chart and database review accessed patient information from the linked BC-wide MS clinical and genetics databases. Data gathered included: demographics (age, sex and ethnicity); clinical characteristics (MS onset date, disease course and disability scores (Expanded Disability Status Scale [EDSS]). Aboriginals were identified via the database linkage augmented by physician and nurse recall. Two non-aboriginal comparator groups with definite MS were selected. Group one included all definite MS patients in the BC MS database, and group two comprised MS patients matched by sex, age at onset and initial disease course. Patient characteristics were compared using the Student’s t-test, chi-squared test, and Kaplan–Meier survival analysis was used to examine disease progression (time to sustained and confirmed EDSS 6) Results: We identified 26 aboriginals with MS, of which 19/26 (73%) were female, 23/26 (89%) had relapsing-onset MS and a mean onset age of 31.1 years. There were no significant differences between the MS aboriginals and the non-matched ( n = 5708) comparator group with respect to age, sex or disease course ( p > 0.1), However, aboriginals progressed more rapidly to EDSS 6 from disease onset ( p < 0.001) when compared with the matched and unmatched comparator groups. Conclusion: We identified a small, but important cohort of aboriginals with MS; being the largest identified to date. There was evidence of more rapid MS progression in aboriginals compared with non-aboriginals.

Long-term survival and competing causes of death in men with stage I seminoma.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 226-226 ◽  
Author(s):  
C. Beard ◽  
M. Chen ◽  
N. D. Arvold ◽  
P. L. Nguyen ◽  
A. K. Ng ◽  
...  
Keyword(s):  
General Population ◽  
Testicular Cancer ◽  
Cancer Mortality ◽  
Stage I ◽  
Second Malignancy ◽  
Term Survival ◽  
All Cause Mortality ◽  
Stage I Seminoma

226 Background: To better understand the impact of RT on mortality, we analyzed long-term survival and patterns of excess mortality in men with stage I seminoma. Methods: 9,045 men with stage I seminoma were identified in the Surveillance Epidemiology and End Results database. Time to testicular-cancer mortality (TCM), death from second malignancy (SM), cardiovascular mortality (CVM) or suicide (SUIC) and all-cause mortality (ACM) were calculated. Survival estimates were calculated using the Kaplan-Meier method. Gender- and age-adjusted standardized mortality ratios (SMR) were calculated using U.S. population data. Cox and Fine and Gray multivariable analysis were used to evaluate the effect of RT on mortality outcomes. Results: 7,025 men (78%) received RT. After a median follow-up of 11.7 years, 869 men (9.6%) had died: sixty-five from TCM, 279 from SM, 169 from CVM and 37 from SUIC. 10-year rates of ACM and TCM were 4.24% and 0.52% among men who received RT and 7.14% and 1.22% among men who did not. Compared to the adjusted general population, men with seminoma had increased risk of ACM (SMR 1.12; 95% confidence interval [CI] 1.12-1.28), SM (SMR 1.78; 95% CI 1.58-2.00) and SUIC (SMR 1.40; 95% CI 1.02-1.94) and decreased risk of CVM (SMR 0.73; 95% CI 0.62-0.84). Rates of ACM, SM and SUIC (SMR, all p < 0.05) were increased whether RT was used or not. Men who received RT were less likely to die (adjusted hazard ratio [AHR] 0.76; 95% CI 0.65-0.89; p < 0.001) and had a lower risk of TCM (AHR 0.39; 95% CI 0.24-0.65; p < 0.001). There was no difference in CVM between men who did and did not receive RT (AHR 0.89; 95% CI 0.60-1.15; p = 0.230) and a numerical increase in SM in men who received RT as compared to others (AHR 1.25; 95% CI 0.90-1.72; p=0.180). Conclusions: Compared to the general population, men with a history of stage I seminoma had increased risks of all-cause mortality, death from second malignancies, and suicide. Our data suggest that 15 years after diagnosis, men who did receive RT may be more likely to die from a second malignancy than men who did not. Although not receiving RT was associated with higher testicular-cancer mortality, the results may reflect decreased access to care or follow-up as active surveillance protocols were not common during the study era. No significant financial relationships to disclose.

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.

scholarly journals Demographic Factors Associated with Insertional and Noninsertional Achilles Tendinopathy

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0027
Author(s):  
Matt Levitsky ◽  
Justin Greisberg ◽  
J Turner Vosseller ◽  
Shirin Dey ◽  
Briana Hickey
Keyword(s):  
Physical Examination ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Characteristics ◽  
Antibiotic Use ◽  
Achilles Tendinopathy ◽  
Insertional Tendinopathy ◽  
Chi Squared ◽  
The Mean ◽  
Student’S T

Category: Sports Introduction/Purpose: Achilles tendinopathy is a common clinical entity encountered by orthopaedic surgeons, although the demographics of patients that suffer from this pathology are incompletely understood. It has been suggested that there may be differences in patients that get insertional (IAT) and noninsertional Achilles tendinopathy (NIAT), and our clinical experience has been that older, less active patients tend to get insertional tendinopathy. The goal of this study is to further investigate the features of patients in a single institution who presented with Achilles tendinopathy. Methods: We used ICD-9 and ICD-10 codes to find patients who presented with Achilles tendinopathy to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, medical comorbidities, and level of activity. Physical examination, including the presence of a gastrocnemius equinus, was noted as well. Characteristics of insertional and non-insertional tendinopathy subgroups were compared using Student’s T-tests and chi- squared tests. Results: The characteristics of 948 consecutive patients were analyzed. The mean age was 55 years and 50.5% of the patients were male. Patients with IAT had significantly higher BMIs than did those with NIAT (30.5 compared to 28.0, p < .05). The mean age was 54.5 years in the IAT group compared to 55.8 years in the NIAT group (p>.05). Patients with NIAT self-identified as active a greater percentage of the time (63% vs 45%, p<0.5). 76% of the IAT group had a gastrocnemius equinus on physical examination, compared to 67% of the non-insertional group. Antecedent fluoroquinolone antibiotic use was only reported in 10% of patients, and all of these patients presented with NIAT. Conclusion: The age at which patients present with insertional and noninsertional Achilles tendinopathy is not significantly different, although patients with NIAT had a lower BMI and self-identified as active a greater percentage of the time. A gastrocnemius equinus was present in a high percentage of patients with both IAT and NIAT. Fluoroquinolone use was not involved in most cases, although, when it was, patients presented with NIAT.

Stage I Seminoma of the Testis: Long Term Results and Toxicity with Adjuvant Radiotherapy

1994 ◽  
Vol 80 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Maurizio Amichetti ◽  
Giovanni Fellin ◽  
Andrea Bolner ◽  
Lucia Busana ◽  
Giuseppe Pani ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stage I ◽  
Long Term Results ◽  
Adjuvant Radiation ◽  
Actuarial Survival ◽  
Curative Intent ◽  
Testicular Seminoma ◽  
Stage I Seminoma ◽  
Cure Rates

Aims and background Pure testicular seminoma has historically been treated with post-orchidectomy radiation therapy with excellent results. Recently, several aspects of the treatment of stage I seminoma have been questioned. We assessed long-term results and toxicity of patients with pure testicular seminoma treated at the Department of Radiation Oncology of S. Chiara Hospital, Trento. Methods From 1953 to 1987, 102 patients with stage I pure testicular seminoma were given megavoltage irradiation with curative intent. All patients had a minimum follow-up of 3 years (maximum 37 years, median 13 years). They received a mean para-aortic/pelvic dose of 33.07 Gy (range 23.70-45.20 Gy) with different doses and fields reflecting the change in techniques over a long period of time. Results The cause-specific actuarial survival at 30 years was 99% and crude survival 67%. One patient had an out-field relapse (inguinal) after a few months and was cured with radiotherapy and chemotherapy. Another patient relapsed with widespared metastases and died after 1 year of progressive disease. Early toxycity was mild and the treatment was well tolerated. Late side effects were reported in 8/102 patients. Conclusion In our series adjuvant radiation therapy resulted in cure rates corresponding to those reported in the literature. The 30-year actuarial survival of 99% was extremely good and the toxicity of the treatment was mild. Post-orchidectomy radiation to the para-aortic and ipsilateral pelvic nodes is a safe and effective method of preventing recurrences and is currently to be considered the treatment of choice in stage I testicular seminoma.

292 THE USE OF ADJUVANT RADIATION THERAPY IN STAGE I SEMINOMA AND ITS EFFECT ON SURVIVAL

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
Christopher Deibert ◽  
Max Kates ◽  
Beverly J. Insel ◽  
Israel Deutsch ◽  
James M. McKiernan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stage I ◽  
Adjuvant Radiation ◽  
Adjuvant Radiation Therapy ◽  
Stage I Seminoma
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