Treatment of Relapse of Clinical Stage I Nonseminomatous Germ Cell Tumors on Surveillance

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Robert J HamiltonMichael A Jewett

Abstract

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). 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. 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...Continue Reading

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Citations

Jun 11, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Christian K KollmannsbergerCraig Nichols
Dec 27, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Stefanie FischerUNKNOWN Global Germ-Cell Cancer Group
Dec 14, 2019·Current Opinion in Urology·Gregory J NasonRobert J Hamilton
Sep 26, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Lucia NappiChristian Kollmannsberger
Mar 20, 2020·JNCI Cancer Spectrum·Craig R NicholsSiamak Daneshmand
Mar 12, 2020·Nature Reviews. Urology·Kristian AlmstrupKlaus-Peter Dieckmann
Aug 1, 2020·The Oncologist·Lucia NappiUNKNOWN Genitourinary Medical Oncologists of Canada (GUMOC)
Feb 25, 2021·Actas urologicas españolas·J Aparicio
May 14, 2021·Journal of Robotic Surgery·G J NasonR J Hamilton
Aug 17, 2021·JACC. CardioOncology·Marish I F J OerlemansNicolaas de Jonge
Nov 14, 2021·Current Opinion in Urology·Jerusha PadayacheeRobert J Hamilton

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