Refinements in the management of testicular germ cell tumours.

Contains fulltext : 50480.pdf (publisher's version ) (Open Access)RU Radboud Universiteit Nijmegen, 21 februari 2006Promotores : Witjes, J.A., Kiemeney, L.A.L.M., Oyen, W.J.G.274 p

Case report: the danger of postchemotherapy laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular carcinoma.

Item does not contain fulltextLaparoscopic retroperitoneal lymph node dissection (RPLND) is a feasible, minimally invasive procedure for the treatment of testicular cancer patients who require surgery to address the retroperitoneal lymph nodes. We report a case of retroperitoneal recurrent disease including a port-site metastasis secondary to laparoscopic RPLND

Prognostic factors in clinical stage 1 non-seminomatous testicular tumours.

Item does not contain fulltextFor patients with a clinical stage 1 non-seminomatous germ cell tumour of the testis cure rates should be close to 100%, whether surveillance, primary surgery, primary chemotherapy or a combination is chosen. The identification of patients with microscopic metastases is difficult. Even with the best predictive factors currently available (vascular invasion and percentage embryonal cell carcinoma in the primary tumour), the identification of micro-metastases is no better than the flip of a coin. Several additional prognostic factors have been studied, but none is yet applicable in daily practice

Recent advances in imaging of male reproductive tract malignancies.

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Efficacy of routine follow-up after first-line treatment for testicular cancer.

To define guidelines for the follow-up management of patients treated for testicular germ cell tumor this study assessed characteristics of patients with recurrent disease. The charts of 505 patients with testicular cancer treated and followed-up at the University Medical Centre Nijmegen between 1982-2000 were reviewed retrospectively. In 42 patients disease recurrence was found during routine follow-up. In a subset of patients no recurrences were seen after first-line treatment: (a) pathological stage IIa nonseminoma patients who were adjuvantly treated with chemotherapy and (b) histologically confirmed complete responders after primary chemotherapy. Furthermore, in low-stage disease no intra-abdominal recurrences were seen in (a) pathological stage I nonseminoma patients and (b) low-stage seminoma patients who received radiotherapy. The risk of recurrent testicular cancer depends on primary therapy and efficacy of it; these results indicate a limited role for follow-up in pathological stage II nonseminoma patients adjuvantly treated with chemotherapy and in histologically confirmed complete responders after chemotherapy. Abdominal computed tomography does not appear necessary in routine follow-up of patients treated for low-stage testicular cancer

Important factors in the diagnosis and primary staging of testicular tumours.

Item does not contain fulltextPURPOSE OF REVIEW: In the present review we outline the use of different staging methods and highlight future possibilities in the management of testicular germ cell cancer. RECENT FINDINGS: The 5-year survival for testicular cancer has improved dramatically over the past 30 years, with cure rates approaching 95%. This success is attributed to the appropriate integration of effective treatments and staging modalities. Staging currently represents the cornerstone on which treatment is based. Because most patients will be cured, attention has shifted toward reducing morbidity of treatment while maintaining high cure rates. This implies that staging must be accurate before any change to the treatment regimen can be instituted. SUMMARY: Effective management of testicular germ cell cancer continues to pose a major challenge. Early and accurate diagnosis is very important because it will influence the choice of treatment and thus may impact on prognosis

Difference in stage and morphology-adjusted survival between young and elderly patients with a testicular germ cell tumor.

Item does not contain fulltextOBJECTIVES: To compare the relative survival in men younger and older than 50 years with a testicular germ cell tumor. METHODS: Data on patients with testicular cancer diagnosed between 1973 and 1997 and registered by one of the nine population-based Surveillance, Epidemiology, and End Results (SEER) cancer registries in the United States were obtained from the National Cancer Institute public domain SEER*Stat 3.0 package. Survival rates adjusted for mortality owing to other causes (ie, relative survival) were calculated for men within each category of the American Joint Committee on Cancer staging system. RESULTS: Patients who developed a germ cell tumor before the age of 50 years had better 10-year relative survival (90.8%, 95% confidence interval 90.6% to 91.0%) than those who developed one after the age of 50 years (84.0%, 95% confidence interval 81.9% to 86.1%). This difference remained after stratification by histologic type and stage, except for patients with localized seminomatous disease (97.9% versus 98.0% for men younger and older than 50 years, respectively). The largest difference in 10-year relative survival was found in men with metastasized disease: seminomatous disease, 89.7% versus 69.6%, and nonseminomatous disease, 76.9% versus 57.0%, for men younger and older than 50 years, respectively. CONCLUSIONS: Lower stage and morphology-adjusted relative survival rate was observed among patients older than 50 years of age with testicular cancer. This difference was more evident in metastasized disease. Whether the worse prognosis in testicular cancer can be explained by a lower tolerance to chemotherapy and/or to suboptimal treatment in the elderly has to be established

Important factors in the diagnosis and primary staging of testicular tumours.

PURPOSE OF REVIEW: In the present review we outline the use of different staging methods and highlight future possibilities in the management of testicular germ cell cancer. RECENT FINDINGS: The 5-year survival for testicular cancer has improved dramatically over the past 30 years, with cure rates approaching 95%. This success is attributed to the appropriate integration of effective treatments and staging modalities. Staging currently represents the cornerstone on which treatment is based. Because most patients will be cured, attention has shifted toward reducing morbidity of treatment while maintaining high cure rates. This implies that staging must be accurate before any change to the treatment regimen can be instituted. SUMMARY: Effective management of testicular germ cell cancer continues to pose a major challenge. Early and accurate diagnosis is very important because it will influence the choice of treatment and thus may impact on prognosis

Cancer incidence in relatives of patients with testicular cancer in the eastern part of The Netherlands.

Item does not contain fulltextOBJECTIVES: To investigate the incidence of malignant tumors in first-degree relatives of patients with testicular cancer. METHODS: Information about the occurrence of cancer in relatives of patients treated for testicular germ cell cancer (TC) at the Department of Urology of the University Medical Centre Nijmegen from 1986 to 1997 was collected using postal questionnaires from 379 (72%) of 524 patients. The expected numbers of cancers in relatives were computed from age- and sex-specific incidence data in the Netherlands Cancer Registry. The observed/expected (O/E) ratios with 95% confidence intervals (CIs) were calculated using Byar's approximation of the exact Poisson test. RESULTS: The O/E ratio for developing cancer in the families of patients with TC was 1.2 (95% CI 1.0 to 1.3). Among first-degree relatives of patients with TC, more TC was observed than expected (O/E 3.3; 95% CI 1.4 to 6.9). The risk for brothers of patients with TC increased 5.9-fold (95% CI 2.2 to 12.8). Both the risk of developing lung cancer (O/E 1.5) and malignancy of the female genital tract in sisters (O/E 2.8) was slightly increased. In contrast, the risk of urinary tract malignancies (O/E 0.3) and other and unknown primary tumors (O/E 0.2) had a lower incidence among relatives. However, both the increased and decreased risk of nontesticular cancer for first-degree relatives may have been caused by misclassification. CONCLUSIONS: TC clusters in families were more pronounced among brothers than among fathers and sons. This study supports previous reports that families of patients with TC do not seem to be prone to nontesticular cancer. Additional investigations in families with TC are recommended to map candidate genes for TC