Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors

Diminishing treatment-related morbidity while maintaining efficacy

C. Kollmannsberger, C. Moore, K. N. Chi, N. Murray, S. Daneshmand, M. Gleave, Brandon Hayes-Lattin, C. R. Nichols

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Background: With treatment leading to nearly uniform cure in clinical stage I nonseminomatous testicular cancer (CSI-NSGCT), diminishing treatment-related morbidity has become the primary concern. This study examined feasibility and outcome of active surveillance as treatment in an unselected CSI patient population. Materials and methods: All patients with CSI-NSGCT referred from 1998 to 2007 to the British Columbia Cancer Agency and the Oregon Testis Cancer Program were retrospectively reviewed. A total of 233 patients were identified, of which 223 chose active surveillance. Results: Vascular invasion (VI) was absent, present and unknown in 66%, 27% and 7% of cases, respectively. Overall, 49% of patients had embryonal predominant disease. Fifty-nine patients (26%) relapsed, all but one with good prognosis disease. VI was present in 30 relapsed patients. Most patients relapsed within 2 years (88%). Only 7 of 223 patients (3%) relapsed beyond 2 years. All relapses were in long-term remission following chemotherapy with or without retroperitoneal lymph node dissection (RPLND). Only 17 of 223 patients (8%) required postorchiectomy surgery. Disease-specific survival is 100% after a median follow-up of 52 months (3-136). No patient has required second-line chemotherapy. Conclusions: Active surveillance for all CSI-NSGCT patients is associated with excellent outcomes comparable with the best results reported with primary RPLND or adjuvant chemotherapy. Nearly 75% of patients are spared any therapy after orchiectomy.

Original languageEnglish (US)
Pages (from-to)1296-1301
Number of pages6
JournalAnnals of Oncology
Volume21
Issue number6
DOIs
StatePublished - Oct 29 2009

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Morbidity
Therapeutics
Testicular Neoplasms
Lymph Node Excision
Blood Vessels
Nonseminomatous germ cell tumor
Testicular Germ Cell Tumor
Drug Therapy
British Columbia
Orchiectomy
Feasibility Studies
Adjuvant Chemotherapy
Outcome Assessment (Health Care)
Recurrence
Survival
Population
Neoplasms

Keywords

  • Nonseminomatous testicular cancer
  • Stage I
  • Surveillance
  • Testis cancer

ASJC Scopus subject areas

  • Oncology
  • Hematology
  • Medicine(all)

Cite this

Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors : Diminishing treatment-related morbidity while maintaining efficacy. / Kollmannsberger, C.; Moore, C.; Chi, K. N.; Murray, N.; Daneshmand, S.; Gleave, M.; Hayes-Lattin, Brandon; Nichols, C. R.

In: Annals of Oncology, Vol. 21, No. 6, 29.10.2009, p. 1296-1301.

Research output: Contribution to journalArticle

Kollmannsberger, C. ; Moore, C. ; Chi, K. N. ; Murray, N. ; Daneshmand, S. ; Gleave, M. ; Hayes-Lattin, Brandon ; Nichols, C. R. / Non-risk-adapted surveillance for patients with stage I nonseminomatous testicular germ-cell tumors : Diminishing treatment-related morbidity while maintaining efficacy. In: Annals of Oncology. 2009 ; Vol. 21, No. 6. pp. 1296-1301.
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