Testicular cancer: When less is more

Current Oncology Reports

Volumn 12, Issue 4, 2010, Pages 271-277

  Pagliaro, Lance C ^a  

^a UNIVERSITY OF TEXAS   (United States)

Author keywords

Carboplatin; Cisplatin; Embryonal carcinoma; Male infertility; Orchiectomy; Radiotherapy; Seminoma; Teratoma; Testicular neoplasm; Treatment related malignancy

Indexed keywords

BLEOMYCIN; CARBOPLATIN; CISPLATIN; ETOPOSIDE;

ADJUVANT THERAPY; CANCER ADJUVANT THERAPY; CANCER RADIOTHERAPY; CANCER STAGING; CLINICAL TRIAL; DISEASE SURVEILLANCE; HUMAN; INTERDISCIPLINARY COMMUNICATION; LYMPH NODE DISSECTION; MALE; MEDICAL DECISION MAKING; MULTIPLE CYCLE TREATMENT; NON SEMINOMATOUS GERMINOMA; ORCHIECTOMY; PARAAORTIC LYMPH NODE; PATIENT SELECTION; RADIATION DOSE; REVIEW; RISK BENEFIT ANALYSIS; SEMINOMA; SINGLE DRUG DOSE; TESTIS CANCER;

CHEMOTHERAPY, ADJUVANT; COMBINED MODALITY THERAPY; GERMINOMA; HUMANS; LYMPH NODE EXCISION; MALE; NEOPLASM STAGING; PROGNOSIS; SEMINOMA; TESTICULAR NEOPLASMS;

EID: 77956445326     PISSN: 15233790     EISSN: None     Source Type: Journal    
DOI: 10.1007/s11912-010-0105-4     Document Type: Review

References (26)

1. Swanson DA: Two courses of chemotherapy after orchidectomy for high-risk clinical stage I nonseminomatous testicular tumours. BJU Int 2005, 95:477-478.
2. Tandstad T, Dahl O, Cohn-Cedermark G, et al.: Risk-adapted treatment in clinical stage I nonseminomatous germ cell testicular cancer: The SWENOTECA management program. J Clin Oncol 2009, 27:2122-2128. In this large prospective study, one or two courses of adjuvant BEP were offered for high-risk patients, and surveillance or one course of BEP for average-risk patients. While this was not a randomized comparison of one versus two courses of BEP, it does show that the recurrence rate is reduced by 90% after just one course.
3. Albers P, Siener R, Krege S, et al.: Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol 2008, 26:2966-2972. In this study, patients were randomized 1:1 to receive either RPLND or one course of adjuvant chemotherapy. The recurrence rate was much higher in the RPLND group. The incidence of teratoma in the chemotherapy group was less than 1%. An unexpectedly high rate of retroperitoneal relapses in the RPLND group was attributed to this being a community-based study in which the experience level of the surgeon was variable.
4. Oliver RT, Mason MD, Mead GM, et al.: Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: A randomised trial. Lancet 2005, 366:293-300.
5. Sharda NN, Kinsella TJ, Ritter MA: Adjuvant radiation versus observation: A cost analysis of alternate management schemes in early-stage testicular seminoma. J Clin Oncol 2006, 14:2933-2939.
6. Buchholz TA, Walden TL, Prestidge BR et al.: Cost-effectiveness of posttreatment surveillance after radiation therapy for early stage seminoma. Cancer 1998, 82:1126-1133.
7. International Germ Cell Consensus Classification: A prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 1997, 15:594-603.
8. Motzer RJ, Agarwal N, Beard C, et al.: NCCN clinical practice guidelines in oncology: Testicular cancer. J Natl Compr Canc Netw 2009, 7:672-693.
9. Stephenson AJ, Bosl GJ, Bajorin DF, et al.: Retroperitoneal lymph node dissection in patients with low stage testicular cancer with embryonal carcinoma predominance and/or lymphovascular invasion. J Urol 2005, 174:557-560; discussion 560.
10. Studer UE, Burkhard FC, Sonntag RW: Risk adapted management with adjuvant chemotherapy in patients with high risk clinical stage I nonseminomatous germ cell tumor. J Urol 2000, 163:1785-1787.
11. de Wit R, Fizazi K: Controversies in the management of clinical stage I testis cancer. J Clin Oncol 2006, 24:5482-5492.
12. Warde P, Specht L, Horwich A, et al.: Prognostic factors for relapse in stage I seminoma managed by surveillance: A pooled analysis. J Clin Oncol 2002, 20:4448-4452.
13. Aparicio J, Germa JR, Garcia del Muro X, et al.: Risk-adapted management for patients with clinical stage I seminoma: The Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol 2005, 23:8717-8723.
14. Powles T, Robinson D, Shamash J, et al.: The long-term risks of adjuvant carboplatin treatment for stage I seminoma of the testis. Ann Oncol 2008, 19:443-447. In this study, 199 patients were followed for a median of 9 years after receiving a single injection of carboplatin. Overall mortality, second cancers, and deaths from circulatory disease were similar to that expected for the population. Five patients (4%) developed a second primary testicular cancer, indicating that carboplatin does not decrease this risk.
15. Santoni R, Barbera F, Bertoni F, et al.: Stage I seminoma of the testis: A bi-institutional retrospective analysis of patients treated with radiation therapy only. BJU Int 2003, 92:47-52; discussion 52.
16. Huyghe E, Matsuda T, Daudin M, et al.: Fertility after testicular cancer treatments: Results of a large multicenter study. Cancer 2004, 100:732-737.
17. van den Belt-Dusebout AW, de Wit R, Gietema JA, et al.: Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol 2007, 25:4370-4378. In this study of 2707 testicular cancer survivors with median follow-up time of 17.6 years, the incidence of second malignancy and cardiovascular disease was compared with the male general population. The increased risk associated with chemotherapy or radiotherapy was similar in magnitude to that of cigarette smoking and persisted more than 25 years after treatment. Cardiovascular risk was not increased for the patients who received subdiaphragmatic radiotherapy only, and neither cardiovascular nor second malignancy risk was increased after surgery alone.
18. Daschle T: Critical: What We Can Do About the Health-Care Crisis. Thomas Dunne Books; New York: 2008.
19. Richie J: Editorial Comment. J Urol 2000, 163:1785-1787.
20. Donohue JP, Foster RS, Rowland RG, et al.: Nerve-sparing retroperitoneal lymphadenectomy with preservation of ejaculation. J Urol 1990, 144:287-291; discussion 291-292.
21. Nichols CR, Kollmannsberger C: Vox populi: Using communitybased studies to determine best management of early-stage nonseminoma. J Clin Oncol 2009, 27:2114-2116.
22. Travis LB, Andersson M, Gospodarowicz M, et al.: Treatmentassociated leukemia following testicular cancer. J Natl Cancer Inst 2000, 92:1165-1171.
23. Amato RJ, Ro JY, Ayala AG, Swanson DA: Risk-adapted treatment for patients with clinical stage I nonseminomatous germ cell tumor of the testis. Urology 2004, 63:144-148; discussion 148-149.
24. Cullen MH, Stenning SP, Parkinson MC, et al.: Short-course adjuvant chemotherapy in high-risk stage I nonseminomatous germ cell tumors of the testis: A Medical Research Council report. J Clin Oncol 1996, 14:1106-1113.
25. Bohlen D, Borner M, Sonntag RW, et al.: Long-term results following adjuvant chemotherapy in patients with clinical stage I testicular nonseminomatous malignant germ cell tumors with high risk factors. J Urol 1999, 161:1148-1152.
26. Westermann DH, Schefer H, Thalmann GN, et al.: Long-term followup results of 1 cycle of adjuvant bleomycin, etoposide and cisplatin chemotherapy for high risk clinical stage I nonseminomatous germ cell tumors of the testis. J Urol 2008, 179:163-166.