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Treatment of stage I testicular germ-cell tumors

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Abstract

More than a half of patients with testicular cancer are diagnosed with clinical stage I disease. In this setting, definitive cure is the rule. However, there is no consensus on the optimal treatment choice. A literature review (1990–2005) was performed in order to identify the pros and the cons associated with each therapy, as well as their long-term outcomes. Several treatment alternatives yield similar efficacy results. Thus, therapy-related morbidity, economic costs, quality-of-life issues, and patient preferences should be considered. Refinement in the knowledge of predictive factors for relapse and amounting experience with both surveillance and adjuvant chemotherapy have led to consideration of risk-adapted treatment policies as an alternative to more traditional approaches (i. e., prophylactic irradiation for seminomas and retroperitoneal lymph node dissection for non-seminomas). In conclusion, with cure rates approaching 100%, close surveillance for low-risk patients and adjuvant chemotherapy for those at high risk of relapse seems the preferred option for clinical stage I testicular cancer, in both seminoma and non-seminoma cases.

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References

  1. Dearnaley DP, Huddart RA, Horwich A. Managing testicular cancer. BMJ 2001; 322: 1583–1588.

    Article  PubMed  CAS  Google Scholar 

  2. Bosl GJ, Motzer RJ. Testicular germ-cell cancer. N Engl J Med 1997; 337: 242–253.

    Article  PubMed  CAS  Google Scholar 

  3. Sonneveld DJA, et al. The changing distribution of stage in nonseminomatous testicular germ cell tumours, from 1977 to 1996. Br J Urol Int 1999; 84: 68–74.

    CAS  Google Scholar 

  4. Germà-Lluch JR, et al. Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish Germ-Cell Cancer Group (GG). Eur Urol 2002; 42 553–563.

    Article  PubMed  Google Scholar 

  5. Chang SS, Roth B. Treatment of clinical stage I germ cell tumors. Urology 2002; 59: 173–179.

    Article  PubMed  Google Scholar 

  6. Jones RH, Vasey PA. Testicular cancer—management of early disease. Lancet Oncol 2003; 4: 730–737.

    Article  PubMed  Google Scholar 

  7. Shelley MD, Burgon K, Mason MD. Treatment of testicular germ-cell cancer: a Cochrane evidence-based systematic review. Cancer Treat Rev 2002; 28: 237–253.

    Article  PubMed  CAS  Google Scholar 

  8. Balk C, Witjes JA. Advances in the management of testicular cancer. Expert Rev Anticancer Ther 2004; 4: 669–677.

    Article  PubMed  CAS  Google Scholar 

  9. Aki FT, Bilen CY, Tekin MI, Ozen H. Is scrotal violation per se a risk factor for local relapse and metastases in stage I nonseminomatous testicular cancer? Urology 2000; 56: 459–462.

    Article  PubMed  CAS  Google Scholar 

  10. Hilton S, et al. CT detection of retroperitoneal lymph node metastases in patients with clinical stage I testicular nonseminomatous germ cell cancer. AJR Am J Roentgenol 1997; 169: 521–525.

    PubMed  CAS  Google Scholar 

  11. Spermon JR, et al. The role of FDG-PET in initial staging and restaging after chemotherapy for testicular germ cell tumours. Br J Urol Int 2002; 89: 549–556.

    CAS  Google Scholar 

  12. Donohue JP, et al. Primary retroperitoneal lymph node dissection in clinical stage A non-seminomatous germ cell testis cancer. Review of the Indiana University experience (1965–1989). Br J Urol 1993; 71: 326–335.

    PubMed  CAS  Google Scholar 

  13. McLeod DG, et al. Staging relationships and outcome in early stage testicular cancer: a report from the Testicular Cancer Intergroup Study. J Urol 1991; 145: 1178–1183.

    PubMed  CAS  Google Scholar 

  14. Heidenreich A, et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol 2003; 169: 1710–1714.

    Article  PubMed  Google Scholar 

  15. Foster R, Donohue JP. Retroperitoneal lymph node dissection for the management of clinical stage I nonseminoma. J Urol 2000; 163: 1788–1792.

    Article  PubMed  CAS  Google Scholar 

  16. Janetschek G, et al. Laparoscopic retroperitoneal lymph node dissection for clinical stage I nonseminomatous testicular carcinoma: long-term outcome. J Urol 2000; 163: 1793–1796.

    Article  PubMed  CAS  Google Scholar 

  17. Heidenreich A, et al. The role of retroperitoneal lymphadenectomy in patients with mature teratomas of the testis. J Urol 1997; 157: 160–163.

    Article  PubMed  CAS  Google Scholar 

  18. Sweeney CJ, et al. Results and outcome of retroperitoneal lymph node dissection for clinical stage I embryonal carcinoma-predominant testis cancer. J Clin Oncol 2000; 18: 358–362.

    PubMed  CAS  Google Scholar 

  19. Rorth M, et al. Surveillance alone versus radiotherapy after orchiectomy for clinical stage I nonseminomatous testicular cancer. J Clin Oncol 1991; 9: 1543–1548.

    PubMed  CAS  Google Scholar 

  20. Zagars GK. Management of stage I seminoma: radiotherapy. In: Horwich A, ed. Testicular Cancer: Investigation and Management, 2nd ed. Chapman & Hall, London, 1996; pp. 99–121.

    Google Scholar 

  21. Hanks GE, Peters T, Owen J. Seminoma of the testis: longterm beneficial and deleterious results of irradiation. Int J Radiat Oncol Biol Phys 1992; 24: 913–919.

    PubMed  CAS  Google Scholar 

  22. Travis L, et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Natl Cancer Inst 1997; 89: 1429–1439.

    Article  PubMed  CAS  Google Scholar 

  23. Zagars GK, Ballo MT, Lee AK, Storm SS. Mortality after cure of testicular seminoma. J Clin Oncol 2004; 22: 640–647.

    Article  PubMed  Google Scholar 

  24. Fossa SD, et al. Optimal planning target volume for stage I testicular seminoma: a Medical Research Council randomised trial. J Clin Oncol 1999; 17: 1146–1154.

    PubMed  CAS  Google Scholar 

  25. Jones WG, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 2005; 23: 1200–1208.

    Article  PubMed  Google Scholar 

  26. Logue JP, et al. Short course para-aortic radiation for stage I seminoma of the testis. Int J Radiat Oncol Biol Phys 2003; 57: 1304–1309.

    Article  PubMed  Google Scholar 

  27. Classen J, et al. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer 2004; 90: 2305–2311.

    PubMed  CAS  Google Scholar 

  28. Read G, et al. Medical Research Council prospective study of surveillance for stage I testicular teratoma. J Clin Oncol 1992; 10: 1762–1768.

    PubMed  CAS  Google Scholar 

  29. Sturgeon JF, et al. Surveillance after orchiectomy for patients with clinical stage I nonseminomatous testis tumors. J Clin Oncol 1992; 10: 564–568.

    PubMed  CAS  Google Scholar 

  30. Germà-Lluch JR, et al. Treatment of stage I testicular tumors. Br J Urol 1993; 71: 473–477.

    PubMed  Google Scholar 

  31. Sogani PC, et al. Clinical stage I testis cancer: long-term outcome of patients on surveillance. J Urol 1998; 159: 855–858.

    Article  PubMed  CAS  Google Scholar 

  32. Koocher G, O'Malley J. The Damocles Syndrome: Psychological Consequences of Surviving Childhood Cancer. McGraw-Hill, New York, 1981.

    Google Scholar 

  33. Fossa SD, et al. How safe is surveillance in patients with histologically low-risk non-seminomatous testicular cancer in a geographically extended country with limited computerized tomographic resources? Br J Cancer 1994; 70: 1156–1160.

    PubMed  CAS  Google Scholar 

  34. Rowland RG, et al. Accuracy of preoperative staging in stage A and B non-seminomatous germ cell testis tumors. J Urol 1982; 127: 718–722.

    PubMed  CAS  Google Scholar 

  35. Boyer MJ, et al. Active surveillance after orchiectomy for nonseminomatous testicular germ cell tumors; late relapse may occur. Urology 1997; 50: 588–592.

    Article  PubMed  CAS  Google Scholar 

  36. Roeleveld TA, et al. Surveillance can be the standard of care for stage I nonseminomatous testicular tumors and even high risk patients. J Urol 2001; 166: 2166–2170.

    Article  PubMed  CAS  Google Scholar 

  37. Heidenreich A. Clinical stage I nonseminomatous testicular germ-cell tumors: surgery or watchful waiting, still an issue? Curr Opin Urol 2002; 12: 427–430.

    Article  PubMed  Google Scholar 

  38. Schmoll HJ, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15: 1377–1399.

    Article  PubMed  CAS  Google Scholar 

  39. Duchesne GM, et al. Orchiectomy alone for stage I seminoma of the testis. Cancer 1990; 65: 1115–1118.

    Article  PubMed  CAS  Google Scholar 

  40. Horwich A, et al. Surveillance following orchidectomy for stage I testicular seminoma. Br J Cancer 1992; 65: 775–778.

    PubMed  CAS  Google Scholar 

  41. von der Maase H, et al. Surveillance following orchiectomy for stage I seminoma of the testis. Eur J Cancer 1993; 14: 1931–1934.

    Article  Google Scholar 

  42. Warde P, et al. Prognostic factors for relapse in stage I testicular seminoma treated with surveillance. J Urol 1997; 157: 1705–1710.

    Article  PubMed  CAS  Google Scholar 

  43. Ramakrishnan S, et al. Stage I seminoma of the testis: is post-orchidectomy surveillance a safe alternative to routine radiotherapy? Clin Oncol 1992; 4: 284–286.

    Article  CAS  Google Scholar 

  44. Allhoff EP, et al. Stage I seminoma of the testis. Adjuvant radiotherapy or surveillance? Br J Urol 1991; 68: 190–194.

    Article  PubMed  CAS  Google Scholar 

  45. Coleman JM, et al. The management and clinical course of testicular seminoma: 15 years' experience at a single institution. Clin Oncol 1998; 10: 237–241.

    Article  CAS  Google Scholar 

  46. 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 1996; 14: 2933–2939.

    PubMed  CAS  Google Scholar 

  47. Warde P, et al. Stage I testicular seminoma: results of adjuvant irradiation and surveillance. J. Clin Oncol 1995; 13: 2255–2262.

    PubMed  CAS  Google Scholar 

  48. Cullen MH, 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.

    PubMed  CAS  Google Scholar 

  49. Böhlen D, et al. Long-term results following adjuvant chemotherapy in patients with clinical stage I nonseminomatous malignant germ cell tumors with high risk factors. J Urol 1999; 161: 1148–1152.

    Article  PubMed  Google Scholar 

  50. Oliver RTD, et al. Pilot study to evaluate impact of a policy of adjuvant chemotherapy for high risk stage I malignant teratoma on overall relapse rate of stage I cancer patients. J Urol 1992; 148: 1453–1456.

    PubMed  CAS  Google Scholar 

  51. Pont J, et al. Adjuvant chemotherapy for high-risk clinical stage I nonseminomatous testicular germ cell cancer: long-term results of a prospective trial. J Clin Oncol 1996; 14: 441–448.

    PubMed  CAS  Google Scholar 

  52. Dearnaley D, et al. Adjuvant bleomycin, vincristine and cisplatin (BOP) for high risk clinical stage I (HRCSI) non-seminomatous germ cell tumours (NSGCT): a Medical Research Council (MRC) pilot study. Proc Am Soc Clin Oncol 1998; 17: abstr 309.

  53. Schefer, H et al. Single course adjuvant bleomycin, etoposide and cisplatin (BEP) for high risk stage I non-seminomatous germ cell tumors (NSGCT). Proc Am Soc Clin Oncol 2000; 19: abstr 340.

    Google Scholar 

  54. Oliver RTD, et al. Pilot studies of 2 and 1 course carboplatin as adjuvant for stage I seminoma: should it be tested in a randomized trial against radiotherapy? Int J Radiat Oncol Biol Phys 1994; 29: 3–8.

    PubMed  CAS  Google Scholar 

  55. Dieckmann KP, et al. Adjuvant treatment of clinical stage I seminoma: is a single course of carboplatin sufficient? Urology 2000; 55: 102–106.

    Article  PubMed  CAS  Google Scholar 

  56. Reiter WJ, et al. Twelve-year experience with two courses of adjuvant single agent carboplatin therapy for clinical stage I seminoma. J Clin Oncol 2001; 19: 101–104.

    PubMed  CAS  Google Scholar 

  57. Steiner H, et al. Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study. Urology 2002; 60: 324–328.

    Article  PubMed  Google Scholar 

  58. Krege S, et al. Phase II study: adjuvant single-agent carboplatin therapy for clinical stage I seminoma. Eur Urol 1997; 31: 405–407.

    PubMed  CAS  Google Scholar 

  59. Nöst G, Lipsky H, Würnschimmel E. Carboplatin-monotherapie im klinischen stadium I des seminoms. Eine akceptable alternative? Urologe A 1998; 37:629–634.

    Article  PubMed  Google Scholar 

  60. Mason MD, et al. Elimination of microscopic metastases from stage I and II seminoma with a single agent single cycle carboplatin: a feasible alternative or adjunt to radiotherapy? (abstr). Br J Cancer 1996; 74 (suppl 28): 15.

    Google Scholar 

  61. Kratzik C, et al. Carboplatin-monotherapie bei seminomen im stadium I. Acta Chir Austriaca 1993; 25: 27–28.

    Google Scholar 

  62. Köpf-Maier P. Effects of carboplatin on the testis. A histological study. Cancer Chemother Pharmacol 1992; 29: 227–235.

    Article  PubMed  Google Scholar 

  63. Reiter WJ, et al. Sperm analysis and serum follicle-stimulating hormone levels before and after adjuvant single-agent carboplatin therapy for clinical stage I seminoma. Urology 1998; 52: 117–119.

    Article  PubMed  CAS  Google Scholar 

  64. Spermon JR, et al. Comparison of surveillance and retroperitoneal lymph node dissection in stage I nonseminomatous germ cell tumors. Urology 2002; 59: 923–929.

    Article  PubMed  CAS  Google Scholar 

  65. Cullen MH, Billingham LJ, Cook J, Woodroffe CM. Management preferences in stage I non-seminomatous germ cell tumours of the testis: an investigation among patients, controls and oncologists. Br J Cancer 1996; 74: 1487–1491.

    PubMed  CAS  Google Scholar 

  66. Albers P, et al. Risk factors for relapse in clinical stage I nonseminomatous testicular germ cell tumors: results of the German Testicular Cancer Study Group trial. J Clin Oncol 2003; 21: 1505–1512.

    Article  PubMed  Google Scholar 

  67. Oliver RTD, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomized trial. Lancet 2005; 366: 293–300.

    Article  PubMed  CAS  Google Scholar 

  68. Heidenreich A, et al. Prognostic risk factors that identify patients with clinical stage I nonseminomatous germ cell tumors at low risk and high risk of for metastases. Cancer 1998; 83: 1002–1011.

    Article  PubMed  CAS  Google Scholar 

  69. Alexandre J, et al. Stage I non-seminomatous germ-cell tumours of the testis: identification of a subgroup of patients with a very low risk of relapse. Eur J Cancer 2001; 37: 576–582.

    Article  PubMed  CAS  Google Scholar 

  70. Vergouwe Y, et al. Predictors of occult metastasis in clinical stage I nonseminoma: a systematic review. J Clin Oncol 2003; 21: 4092–4099.

    Article  PubMed  Google Scholar 

  71. Warde P, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance a pooled analysis. J Clin Oncol 2002; 20: 4448–4452.

    Article  PubMed  Google Scholar 

  72. Klepp O, et al. Risk-adapted treatment of clinical stage I non-seminoma testis cancer. Eur J Cancer 1997; 33: 1038–1044.

    Article  PubMed  CAS  Google Scholar 

  73. Ondrus D, et al. Prognostic factors in clinical stage I non-seminomatous germ cell testicular tumors: Rationale for different risk-adapted treatment. Eur Urol 1998; 33: 562–566.

    Article  PubMed  CAS  Google Scholar 

  74. Studer UE, et al. Adjuvant chemotherapy after orchiectomy in high-risk patients with clinical stage I non-seminomatous testicular cancer. Eur Urol 1993; 23: 444–449.

    PubMed  CAS  Google Scholar 

  75. Maroto P, et al. Multicenter risk-adapted management for stage I non-seminomatous germ cell tumours. Ann Oncol 2005; 16: 1915–1920.

    Article  PubMed  CAS  Google Scholar 

  76. Oliver RTD, et al. Long-term follow-up of Anglian Germ Cell Cancer Group surveillance versus patients with stage I nonseminoma treated with adjuvant chemotherapy. Urology 2004; 63: 556–561.

    Article  PubMed  CAS  Google Scholar 

  77. Aparicio J, et al. Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol 2003; 14: 867–872.

    Article  PubMed  CAS  Google Scholar 

  78. Aparicio J, et al. Risk-adapted management for patients with clinical stage I seminoma: the second Spanish Germ Cell Cancer Group study. J Clin Oncol 2005; 23: 8717–8723.

    Article  PubMed  Google Scholar 

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  1. Department of Medical Oncology, Hospital Universitario La Fe, Valencia, Spain

    J. Aparicio

  2. Department of Medical Oncology, Idibell-Institut Català D'Oncologia Duran i Reynals, Barcelona, Spain

    J. R. Germa

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Aparicio, J., Germa, J.R. Treatment of stage I testicular germ-cell tumors. Med Oncol 23, 305–315 (2006). https://doi.org/10.1385/MO:23:3:305

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