RESUMO
ABSTRACT Purpose: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. Materials and Methods: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. Results: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. Conclusions: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.
Assuntos
Humanos , Masculino , Neoplasias Testiculares/radioterapia , Padrões de Prática Médica/estatística & dados numéricos , Seminoma/radioterapia , Conduta Expectante/métodos , Radio-Oncologistas/estatística & dados numéricos , Neoplasias Testiculares/patologia , Neoplasias Testiculares/tratamento farmacológico , Estados Unidos , Conhecimentos, Atitudes e Prática em Saúde , Vigilância da População/métodos , Inquéritos e Questionários , Quimioterapia Adjuvante , Seminoma/patologia , Seminoma/tratamento farmacológico , Progressão da Doença , Estadiamento de NeoplasiasRESUMO
PURPOSE: Most men with stage I testicular seminoma are cured with surgery alone, which is a preferred strategy per national guidelines. The current pattern of practice among US radiation oncologists (ROs) is unknown. MATERIALS AND METHODS: We surveyed practicing US ROs via an online questionnaire. Respondent's characteristics, self-rated knowledge, perceived patient compliance rates with observation were analyzed for association with treatment recommendations. RESULTS: We received 353 responses from ROs, of whom 23% considered themselves experts. A vast majority (84%) recommend observation as a default strategy, however this rate drops to 3% if the patient is believed to be noncompliant. 33% of respondents believe that survival is jeopardized in case of disease recurrence, and among these respondents only 5% support observation. 22% of respondents over-estimate the likelihood of noncompliance with observation to be in the 50-80% range. Responders with a higher perceived noncompliance rate are more likely to recommend adjuvant therapy (Fisher's exact p<0.01). Only 7% of respondents recommend observation for stage IS seminoma and 45% administer adjuvant RT in patients with elevated pre-orchiectomy alpha-fetal protein levels. CONCLUSIONS: Many US ROs over-estimate the likelihood that stage I testicular seminoma patients will be noncompliant with surveillance and incorrectly believe that overall survival is jeopardized if disease recurs on surveillance. Observation is quickly dismissed for patients who are not deemed to be compliant with observation, and is generally not accepted for patients with stage IS disease. There is clearly an opportunity for improved physician education on evidence-based management of stage I testicular seminoma.
Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Seminoma/radioterapia , Neoplasias Testiculares/radioterapia , Conduta Expectante/métodos , Quimioterapia Adjuvante , Progressão da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Estadiamento de Neoplasias , Vigilância da População/métodos , Seminoma/tratamento farmacológico , Seminoma/patologia , Inquéritos e Questionários , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Estados UnidosRESUMO
OBJECTIVES: To evaluate post-orchiectomy utilization of radiation therapy (RT) versus other management approaches in stage IIA and IIB testicular seminoma patients. MATERIALS AND METHODS: Two hundred and forty-one patients with stage IIA and IIB testicular seminoma were identified between 1988 and 2003 using the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: Median follow-up was 10 years. Patients with stage IIA disease underwent RT more frequently than those with stage IIB disease (72 % vs. 46 %, respectively; P < 0.001). There was no significant change in RT utilization for stage IIA or IIB disease between 1988 and 2003 (P = 0.89). CONCLUSIONS: Between 1988 and 2003, stage IIA patients underwent RT more often than stage IIB patients in the United States. There was no significant change in RT utilization for stage IIA or IIB disease during this time period. Based on reports describing excellent progression-free survival with cisplatin-based chemotherapy, this approach has increased in popularity since 2003 and may eventually become the most popular treatment approach for both stage IIA and IIB testicular seminoma.
Assuntos
Orquiectomia , Seminoma/patologia , Seminoma/radioterapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/radioterapia , Adolescente , Adulto , Idoso , Intervalo Livre de Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Fatores de Risco , Programa de SEER , Seminoma/mortalidade , Seminoma/cirurgia , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/cirurgia , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Objectives To evaluate post-orchiectomy utilization of radiation therapy (RT) versus other management approaches in stage IIA and IIB testicular seminoma patients. Materials and Methods Two hundred and forty-one patients with stage IIA and IIB testicular seminoma were identified between 1988 and 2003 using the Surveillance, Epidemiology, and End Results (SEER) database. Results Median follow-up was 10 years. Patients with stage IIA disease underwent RT more frequently than those with stage IIB disease (72% vs. 46%, respectively; P<0.001). There was no significant change in RT utilization for stage IIA or IIB disease between 1988 and 2003 (P = 0.89). Conclusions Between 1988 and 2003, stage IIA patients underwent RT more often than stage IIB patients in the United States. There was no significant change in RT utilization for stage IIA or IIB disease during this time period. Based on reports describing excellent progression-free survival with cisplatin-based chemotherapy, this approach has increased in popularity since 2003 and may eventually become the most popular treatment approach for both stage IIA and IIB testicular seminoma. .
Assuntos
Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Orquiectomia , Seminoma/patologia , Seminoma/radioterapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/radioterapia , Intervalo Livre de Doença , Seguimentos , Estimativa de Kaplan-Meier , Estadiamento de Neoplasias , Período Pós-Operatório , Fatores de Risco , Programa de SEER , Seminoma/mortalidade , Seminoma/cirurgia , Fatores de Tempo , Resultado do Tratamento , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/cirurgiaRESUMO
Evaluar los resultados obtenidos con radioterapia adyuvante. Se analizaron 40 historias clínicas de pacientes con diagnóstico de cáncer de testículo estadio I; todos recibieron radioterapia adyuvante entre abril de 1992 y mayo de 2004. El tipo histológico fue seminoma. El diagnóstico y la estadificación se efectuaron con ecografía testicular, determinación de marcadores tumorales, tomografía axial computada de abdomen y pelvis y radiografía de tórax. Los pacientes fueron tratados con unidad de cobalto 60 y acelerador lineal de 6 MV de fotones. Volúmenes: región ganglionar lumboaórtica y pelviana ipsilateral vs. lumboaórtica solamente. Dosis diaria: 1,8 Gy Dosis total: 30,6 Gy. El seguimiento se efectuó durante 3 años con radiografía de tórax y tomografía axial computada de abdomen y pelvis a los doce meses y luego un control clínico completo una vez por año. Se definió la tasa de recidiva en ganglios pelvianos ipsilaterales (0 por ciento vs. 6,25 por ciento), progresión a distancia (8,3 por ciento vs. 0 por ciento) y supervivencia global (100 por ciento vs. 100 por ciento) a tres años de seguimiento. Nuestro resultado es similar a lo publicado en la bibliografía internacional. Teniendo en cuenta el escaso número de pacientes, no se evidenció cambios en la supervivencia global en el agregado de radioterapia a ganglios pelvianos ipsilaterales. La radioterapia a ganglios lumbo-aórticos es el tratamiento habitual, siendo necesario optimizar la modalidad de la radioterapia con técnicas en tres dimensiones o intensidad modulada para disminuir la toxicidad a largo tiempo.
To evaluate the results obtained with adyuvant radiotherapy. We analyzed 40 clinic histories of testis cancer stage I diagnosed patients were studied. All of them received adyuvant radiotherapy between April 1992 and May 2004. The most common histological type was seminoma. The diagnosis and the staging were done through testicular ultrasound, serum tumor markers determination, abdomen and pelvis CT, and chest Rx films. The patients were treated with Cobalto 60 unit and linear accelerator of 6 Mev of photons. Volume: Para-aortic and paracaval lymph node region and ipsilateral illiac node region vs. para-aortic and paracaval lymph node region only. Daily dose: 1.8 Gy total doses 30.6 Gy. Followup was done during 3 years with chest Rx and abdomen and pelvis CT at 12 months, and a whole clinic check-up once a year. Recurrence rate in ipsilateral iliac nodes (0 % vs. 6.25 %) distance progression (8.3 % vs. 0%) and global survival (100 % vs. 100 %) in three years follow-up was established. Our results are similar to the ones published in world literature. Bearing in mind the scarce number of patients, changes in global survival were not shown when radiotherapy in ipsilateral illiac nodes was added. Radiation therapy in para-aortic and paracaval lympth nodes is the standard treatment, there is being necessary to optimize the radiotherapy modality with other radiation therapy techniques: In three dimension and modulated intensity to diminish the long term toxicity.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Neoplasias Testiculares/radioterapia , Resultado do Tratamento , Seminoma/radioterapia , Oncologia , SobrevivênciaRESUMO
We present 4 case studies of patients with Down's syndrome and testicular germ-cell cancer, treated with conventional methods at the National Cancer Institute of Mexico, with similar outcomes as patients without this syndrome. There are several reports of testicular cancer arising in patients with Down's syndrome worldwide, mainly from Caucasian populations. We discuss some theories about the association and the possible increase of incidence.
Assuntos
Síndrome de Down/complicações , Neoplasias Embrionárias de Células Germinativas/complicações , Neoplasias Testiculares/complicações , Anormalidades Múltiplas , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bleomicina/administração & dosagem , Neoplasias Encefálicas/secundário , Cisplatino/administração & dosagem , Terapia Combinada , Criptorquidismo/complicações , Etoposídeo/administração & dosagem , Evolução Fatal , Humanos , Neoplasias Pulmonares/secundário , Metástase Linfática , Masculino , México , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Indução de Remissão , Neoplasias Retroperitoneais/radioterapia , Neoplasias Retroperitoneais/secundário , Seminoma/complicações , Seminoma/patologia , Seminoma/radioterapia , Seminoma/cirurgia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Radical orchiectomy is the standard treatment for patients with seminoma. In both bilateral and unilateral testicular cancer, this therapy results in infertility, permanent androgen replacement treatment and significant psychological problems stemming from castration. Given that most patients with germinal cell tumours are long-term survivors, quality of life is becoming more and more relevant in therapeutic decision-making. We present a case of metachronous bilateral seminoma treated with tumour enucleation and adjuvant local radiotherapy. We also provide a review of the literature on the role of radiotherapy in organ sparing.
Assuntos
Radioterapia/métodos , Seminoma/radioterapia , Neoplasias Testiculares/radioterapia , Adulto , Humanos , Infertilidade Masculina/prevenção & controle , Masculino , Dosagem Radioterapêutica , Seminoma/reabilitação , Neoplasias Testiculares/reabilitaçãoRESUMO
Males are affected from primary extragonadal germ cell tumors with a frequency of 2 to 5%. There is a high incidence of infertility of more than 60% and most of the cases have azoospermia due to testicular damage. The hormonal profile of these patients shows normal luteinizing hormone, normal follicle stimulating hormone and normal testosterone and estradiol. We communicate the case of a male who had a primary retroperitoneal germ cell tumor with a low title of chorionic gonadotropin, elevated estradiol and normal testosterone, prolactin and seminogram. Before beginning treatment with chemotherapy, his wife became pregnant delivering twins, both males. The patient was treated with chemo and radiotherapy after which he became azoospermic with an increase in both luteinizing hormone and follicle stimulating, decreased levels of estradiol and without alteration in prolactin and testosterone. The pituitary testicle axis was affected by the tumor, but the microenvironment of the testicles did not seem to be damaged only after initiating treatment.
Assuntos
Neoplasias Retroperitoneais/fisiopatologia , Seminoma/fisiopatologia , Testículo/fisiopatologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Azoospermia/sangue , Azoospermia/etiologia , Gonadotropina Coriônica/sangue , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Feminino , Fertilidade , Hormônio Foliculoestimulante/sangue , Humanos , Sistema Hipotálamo-Hipofisário/fisiologia , Recém-Nascido , Hormônio Luteinizante/sangue , Masculino , Gravidez , Gravidez Múltipla , Radioterapia Adjuvante/efeitos adversos , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias Retroperitoneais/radioterapia , Seminoma/tratamento farmacológico , Seminoma/radioterapia , Testosterona/sangue , GêmeosRESUMO
La mayoría de los pacientes son seminoma estadio I son tratados con orquiectomía y radioterapia a los ganglios retroperitoneales. Esto se debe a que el seminoma es extraordinariamente sensible a la radioterapia y los resultados son excelentes, con una sobrevida libre de enfermedad de alrededor del 99 por ciento. Sin embargo, recientemente algunos oncólogos han propuesto tratar los enfermos solamente con orquiectomía y observación. Es fundamental para esta nueva modalidad de tratamiento que los enfermos que presenten progresión de la enfermedad puedan ser tratados oportunamente y adecuadamente con radioterapia o quimioterapia