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Active surveillance as a successful management strategy for patients with clinical stage I germ cell testicular cancer.
- Source :
-
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico [Clin Transl Oncol] 2019 Jun; Vol. 21 (6), pp. 796-804. Date of Electronic Publication: 2018 Nov 23. - Publication Year :
- 2019
-
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.<br />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.<br />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.<br />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.
- Subjects :
- Adolescent
Adult
Aged
Disease Management
Follow-Up Studies
Humans
Longitudinal Studies
Male
Middle Aged
Neoplasms, Germ Cell and Embryonal diagnostic imaging
Neoplasms, Germ Cell and Embryonal surgery
Prognosis
Retrospective Studies
Survival Rate
Testicular Neoplasms diagnostic imaging
Testicular Neoplasms surgery
Watchful Waiting standards
Young Adult
Multimodal Imaging methods
Neoplasms, Germ Cell and Embryonal prevention & control
Orchiectomy mortality
Population Surveillance
Testicular Neoplasms prevention & control
Watchful Waiting statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1699-3055
- Volume :
- 21
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
- Publication Type :
- Academic Journal
- Accession number :
- 30470992
- Full Text :
- https://doi.org/10.1007/s12094-018-1990-5