PURPOSE: Active surveillance (AS) for testicular nonseminomatous germ cell tumors (NSGCT) is widely used. Although there is no consensus for optimal treatment at relapse on surveillance, globally patients typically receive chemotherapy. We describe treatment of relapses in our non-risk-adapted NSGCT AS cohort and highlight selective use of primary retroperitoneal lymph node dissection (RPLND). METHODS: From December 1980 to December 2015, 580 patients with clinical stage I NSGCT were treated with AS, and 162 subsequently relapsed. First-line treatment was based on relapse site and extent. Logistic regression was used to explore factors associated with need for multimodal therapy on AS relapse. RESULTS: Median time to relapse was 7.4 months. The majority of relapses were confined to the retroperitoneum (66%). After relapse, first-line treatment was chemotherapy for 95 (58.6%) and RPLND for 62 (38.3%), and five patients (3.1%) underwent other therapy. In 103 (65.6%), only one modality of treatment was required: chemotherapy only in 58 of 95 (61%) and RPLND only in 45 of 62 (73%). Factors associated with multimodal relapse therapy were larger node size (odds ratio, 2.68; P = .045) in patients undergoing chemotherapy and elevated tumor markers (odds ratio, 6.05; P = .008) in patients undergoing RPLND. When RPLND was performed with normal markers, 82% required no further treatment. Second relapse occurred in 30 of 162 patients (18.5%). With median follow-up of 7.6 years, there were five deaths (3.1% of AS relapses, but 0.8% of whole AS cohort) from NSGCT or treatment complications. CONCLUSION: The retroperitoneum is the most common site of relapse in clinical stage I NSGCT on AS. Most are cured by single-modality treatment. RPLND should be considered for relapsed patients, especially those with disease limited to the retroperitoneum and normal markers, as an option to avoid chemotherapy.
PURPOSE: Active surveillance (AS) for testicular nonseminomatous germ cell tumors (NSGCT) is widely used. Although there is no consensus for optimal treatment at relapse on surveillance, globally patients typically receive chemotherapy. We describe treatment of relapses in our non-risk-adapted NSGCT AS cohort and highlight selective use of primary retroperitoneal lymph node dissection (RPLND). METHODS: From December 1980 to December 2015, 580 patients with clinical stage I NSGCT were treated with AS, and 162 subsequently relapsed. First-line treatment was based on relapse site and extent. Logistic regression was used to explore factors associated with need for multimodal therapy on AS relapse. RESULTS: Median time to relapse was 7.4 months. The majority of relapses were confined to the retroperitoneum (66%). After relapse, first-line treatment was chemotherapy for 95 (58.6%) and RPLND for 62 (38.3%), and five patients (3.1%) underwent other therapy. In 103 (65.6%), only one modality of treatment was required: chemotherapy only in 58 of 95 (61%) and RPLND only in 45 of 62 (73%). Factors associated with multimodal relapse therapy were larger node size (odds ratio, 2.68; P = .045) in patients undergoing chemotherapy and elevated tumor markers (odds ratio, 6.05; P = .008) in patients undergoing RPLND. When RPLND was performed with normal markers, 82% required no further treatment. Second relapse occurred in 30 of 162 patients (18.5%). With median follow-up of 7.6 years, there were five deaths (3.1% of AS relapses, but 0.8% of whole AS cohort) from NSGCT or treatment complications. CONCLUSION: The retroperitoneum is the most common site of relapse in clinical stage I NSGCT on AS. Most are cured by single-modality treatment. RPLND should be considered for relapsed patients, especially those with disease limited to the retroperitoneum and normal markers, as an option to avoid chemotherapy.
Authors: Robert J Hamilton; Christina Canil; Noa Shani Shrem; Kopika Kuhathaas; Maria Di Jiang; Peter Chung; Scott North; Piotr Czaykowski; Sebastien Hotte; Eric Winquist; Christian Kollmannsberger; Armen Aprikian; Denis Soulières; Scott Tyldesley; Alan I So; Nicholas Power; Ricardo A Rendon; Martin O'Malley; Lori Wood; Michael A S Jewett Journal: Can Urol Assoc J Date: 2022-06 Impact factor: 2.052
Authors: Lucia Nappi; Marisa Thi; Amy Lum; David Huntsman; Bernie J Eigl; Christopher Martin; Brock O'Neil; Benjamin L Maughan; Kim Chi; Alan So; Peter C Black; Martin Gleave; Alex W Wyatt; Jean Michel Lavoie; Daniel Khalaf; Robert Bell; Siamak Daneshmand; Robert J Hamilton; Ricardo R N Leao; Craig Nichols; Christian Kollmannsberger Journal: J Clin Oncol Date: 2019-09-25 Impact factor: 50.717
Authors: Lucia Nappi; Margaret Ottaviano; Pasquale Rescigno; Marianna Tortora; Giuseppe L Banna; Giulia Baciarello; Umberto Basso; Christina Canil; Alessia Cavo; Maria Cossu Rocca; Piotr Czaykowski; Ugo De Giorgi; Xavier Garcia Del Muro; Marilena Di Napoli; Giuseppe Fornarini; Jourik A Gietema; Daniel Y C Heng; Sebastien J Hotte; Christian Kollmannsberger; Marco Maruzzo; Carlo Messina; Franco Morelli; Sasja Mulder; Craig Nichols; Franco Nolè; Christoph Oing; Teodoro Sava; Simona Secondino; Giuseppe Simone; Denis Soulieres; Bruno Vincenzi; Paolo A Zucali; Sabino De Placido; Giovannella Palmieri Journal: Oncologist Date: 2020-09-18 Impact factor: 5.837