Management of testicular neoplasms in France and compliance with national guidelines.

Abstract

4580 Background: Testicular neoplasms (TN) are uncommon and curable tumors with standardized treatment. Guidelines are available. Treatments may lead to adverse effects (long-term severe toxicities, secondary cancer), occurring among young men. Our aim was to describe the primary TN management in France and to evaluate compliance with the national guidelines. Methods: Cases of TN diagnosed in 2003-2004 were identified from 11 general official exhaustive cancer registries. A detailed medical chart was used to collect individual data on tumor description and management. National guidelines published in 2002 were used as reference (Progrès en Urologie 2002;12:71-78). A conformity list was defined by a group of experts. Each criterion could be in accordance with the recommendations, severely noncompliant (disagreement with the recommendations with a potential impact on outcome), marginally noncompliant (no effect on patient outcome) and noncompliant but justifiable (noncompliance explained by patient or tumor characteristics). Results: 256 patients with testicular seminoma (TS) and 197 with testicular nonseminoma (TNS) were included: 69% had a stage I, 16% a stage II, 16% a stage III and 11% an undetermined one. Globally only 10% of patients with TS and 12% with TNS received a totally conform management (all stages combined). When restricting to therapeutic steps only, conformity to standard guideline was 44% and 28% respectively for TS and TNS. Most severe noncompliance are summarized in the Table. Conclusions: Based on exhaustive French cancer registries, the real-life TN management is quite disappointing, specially for pretherapeutic step, surveillance for TNS, chemotherapy for TNS and TS and post chemotherapy surgery. This study highlights the need for larger guidelines diffusion on every contributor (pathologist, urologist, medical oncologist and radio-oncologist). It might also be considered as a plea for patients’ centralization in reference centers. TS TNS Tumor markers at diagnosis 40% 33% Histology report 35% 46% Radiotherapy 31% / Chemotherapy 62% 58% Active surveillance only / 95% Postchemotherapy lymph node dissection / 70% No significant financial relationships to disclose.