INTRODUCTION: More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 25-35 years. About half of testicular cancers are seminomas, which tend to affect older men and have a good prognosis. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in men with stage 1 seminoma (confined to testis) who have undergone orchidectomy? What are the effects of treatments in men with good-prognosis non-stage 1 seminoma who have undergone orchidectomy? What are the effects of maintenance chemotherapy in men in remission after orchidectomy and chemotherapy for good-prognosis non-stage 1 seminoma? What are the effects of treatments in men with intermediate-prognosis seminoma who have undergone orchidectomy? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant irradiation (20 Gy in 10 fractions to paraaortic area, 30 Gy in 15 fractions to paraaortic area and iliac nodes), chemotherapy (maintenance, adjuvant, single-agent carboplatin, three or four cycles, different number of cycles of adjuvant, using bleomycin added to vinblastine plus cisplatin, using etoposide plus cisplatin with or without bleomycin, adding higher doses to a two-drug chemotherapy regimen using cisplatin or vinblastine), radiotherapy (adjuvant, different drug combinations, 30-36 Gy in 15-18 fractions), surveillance.
INTRODUCTION: More than half of painless solid swellings of the body of the testis are malignant, with a peak incidence in men aged 25-35 years. About half of testicular cancers are seminomas, which tend to affect older men and have a good prognosis. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in men with stage 1 seminoma (confined to testis) who have undergone orchidectomy? What are the effects of treatments in men with good-prognosis non-stage 1 seminoma who have undergone orchidectomy? What are the effects of maintenance chemotherapy in men in remission after orchidectomy and chemotherapy for good-prognosis non-stage 1 seminoma? What are the effects of treatments in men with intermediate-prognosis seminoma who have undergone orchidectomy? We searched: Medline, Embase, The Cochrane Library and other important databases up to April 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant irradiation (20 Gy in 10 fractions to paraaortic area, 30 Gy in 15 fractions to paraaortic area and iliac nodes), chemotherapy (maintenance, adjuvant, single-agent carboplatin, three or four cycles, different number of cycles of adjuvant, using bleomycin added to vinblastine plus cisplatin, using etoposide plus cisplatin with or without bleomycin, adding higher doses to a two-drug chemotherapy regimen using cisplatin or vinblastine), radiotherapy (adjuvant, different drug combinations, 30-36 Gy in 15-18 fractions), surveillance.
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Authors: Ragnar Westerling; Marcus Westin; Martin McKee; Rasmus Hoffmann; Iris Plug; Grégoire Rey; Eric Jougla; Katrin Lang; Kersti Pärna; José L Alfonso; Johan P Mackenbach Journal: J Eval Clin Pract Date: 2014-04-22 Impact factor: 2.431