Re: Patterns of Relapse in Patients with Clinical Stage I Testicular Cancer Managed with Active Surveillance

Re: Patterns of Relapse in Patients with Clinical Stage I Testicular Cancer Managed with Active Surveillance

930 TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Patterns of Relapse in ...

35KB Sizes 1 Downloads 29 Views

930

TESTIS CANCER AND ADVANCES IN ONCOLOGIC THERAPY

Urological Oncology: Testis Cancer and Advances in Oncologic Therapy Re: Patterns of Relapse in Patients with Clinical Stage I Testicular Cancer Managed with Active Surveillance C. Kollmannsberger, T. Tandstad, P. L. Bedard, G. Cohn-Cedermark, P. W. Chung, M. A. Jewett, T. Powles, P. R. Warde, S. Daneshmand, A. Protheroe, S. Tyldesley, P. C. Black, K. Chi, A. I. So, M. J. Moore and C. R. Nichols Vancouver Cancer Center, British Columbia Cancer Agency and Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, and University Health Network-Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada, St. Olavs University Hospital, Trondheim, Norway, Radiumhemmet, Karolinska Institute and University Hospital, Stockholm, Sweden, Bart’s Cancer Institute, St. Bartholomew’s Hospital, London and University of Oxford, Churchill Hospital, Oxford, United Kingdom, Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, California, and Section of Hematology/Oncology, Virginia Mason Medical Center, Seattle, Washington J Clin Oncol 2015; 33: 51e57. doi: 10.1200/JCO.2014.56.2116

Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25135991 Editorial Comment: Active surveillance has become the preferred approach for patients with clinical stage I (CSI) seminoma and those with low risk clinical stage I nonseminomatous germ cell tumors (NSGCTs). With highly effective salvage chemotherapy the ultimate cure rates approach 100%. Thus, reducing management related morbidity while maintaining uniform cure rates has become the overriding concern. The authors, from a number of institutions using active surveillance, have compiled their data in a retrospective study of 2,483 patients with clinical stage I testicular tumor, 1,139 with nonseminoma and 1,344 with seminoma who were treated between 1998 and 2010. Relapse occurred in 221 patients (19%) with CSI NSGCT and 173 (13%) with CSI seminoma. Median time to relapse was 4 months (range 2 to 61) for patients with lymphovascular invasion (LVI) positive NSGCT, 8 months (2 to 77) for those with LVI negative NSGCT and 14 months (2 to 84) for those with CSI seminoma. Importantly relapse was noted in 44% of patients with LVI positive NSGCT. Most relapses were detected within 2 years for NSGCT cases and within 3 years for seminoma cases. Relapses were detected by computerized tomography in 87% of patients with seminoma and 45% of those with NSGCT. Three patients with NSGCT died of disease and 3 died of treatment related events. Although active surveillance leads to overall good outcomes, risk stratification still has an important role in decisions for therapy. In patients on active surveillance data such as these may allow refinement of surveillance schedules. Jerome P. Richie, MD