Seminoma Stage Research Articles

Primary retroperitoneal lymph node dissection (RPLND) in seminoma stage IIA-IIC ≤3cm: Combined results of the SWENOTECA (Swedish Norwegian Testicular Cancer Group) and Cologne.

Background: Chemotherapy or radiotherapy have been standard treatment for stage II seminomas with excellent survival but are associated with significant long-term treatment-related toxicities. Several prospective trials have shown primary retroperitoneal lymph node dissection (RPLND) to be an effective and safe alternative. The current SWENOTECA treatment program recommends primary RPLND in seminoma stage IIA to IIB ≤ 3 cm with 1-2 metastatic nodes as the standard treatment modality. We present preliminary results combined with data from Cologne. Methods: Within SWENOTECA, RPLND is centralized to 5 hospitals and Cologne is a tertiary centre for patients recruited from different parts of Germany. Both patients with recurrence after initial stage I disease and patients with primary stage IIA and IIB at diagnosis were included. We collected information on operation time, bleeding, peri- and postoperative complications. We also analyzed histologic outcome and whether adjuvant chemotherapy was given. We followed the patients for any recurrence of disease. Results: We have included 94 patients operated from May 2018 to November 2022. The number of operations per site varied from 4 to 28. The mean age of patients at time of RPLND was 41.8 years (range 21-79). Overall, 54 patients had recurrence after initial stage I disease and 40 patients had primary stage IIA/IIB disease at diagnosis (one missing data). At time of RPLND 62 patients had IIA-disease and 31 stage IIB-disease (one missing data). The histology from RPLND showed seminoma in 83 patients, benign/necrosis in eight patients, vital non-seminomatous GCT in one patient, teratoma only in one patient and lymphoma in one patient. Mean number of resected nodes was 19, and mean number of positive nodes were 1.5. Twenty-six patients (28%) were operated with robotic laparoscopic technique. Ten patients (10.6%) had a Clavien-Dindo postoperative complication > 2. Twenty-three of the patients were given adjuvant oncological treatment after RPLND, most of them one course of BEP. The patients have been followed for in median 18 months (range 2-59). Nine patients (9.6 %) have had recurrences, all but one in the first year after RPLND. Conclusions: Our early results of primary RPLND of seminomas IIA-IIB ≤ 3 cm are promising. Longer follow-up is required to ensure this as a safe treatment option.

MP33-04 THE EARLY RESULTS OF THE SWENOTECA (SWEDISH NORWEGIAN TESTICULAR CANCER GROUP) INTRODUCTION OF PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) IN SEMINOMA STAGE IIA-IIB ≤ 3cm

You have accessJournal of UrologyCME1 Apr 2023MP33-04 THE EARLY RESULTS OF THE SWENOTECA (SWEDISH NORWEGIAN TESTICULAR CANCER GROUP) INTRODUCTION OF PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) IN SEMINOMA STAGE IIA-IIB ≤ 3cm Anna Thor, Axel Gerdtsson, Bjarte Almas, Dag Halvorsen, Gabriella Cohn Cedermark, Helene Neegaard, Ingrid Glimelius, Hege Sagstuen Haugnes, Asa Karlsdottir, Olof Stahl, Signe Melsen Larsen, Anna Grenabo Bergdahl, Torgrim Tandstad, and Anders Kjellman Anna ThorAnna Thor More articles by this author , Axel GerdtssonAxel Gerdtsson More articles by this author , Bjarte AlmasBjarte Almas More articles by this author , Dag HalvorsenDag Halvorsen More articles by this author , Gabriella Cohn CedermarkGabriella Cohn Cedermark More articles by this author , Helene NeegaardHelene Neegaard More articles by this author , Ingrid GlimeliusIngrid Glimelius More articles by this author , Hege Sagstuen HaugnesHege Sagstuen Haugnes More articles by this author , Asa KarlsdottirAsa Karlsdottir More articles by this author , Olof StahlOlof Stahl More articles by this author , Signe Melsen LarsenSigne Melsen Larsen More articles by this author , Anna Grenabo BergdahlAnna Grenabo Bergdahl More articles by this author , Torgrim TandstadTorgrim Tandstad More articles by this author , and Anders KjellmanAnders Kjellman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003266.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemotherapy or radiotherapy have been the standard treatment for stage II seminomas with excellent results for survival but associated with significant long-term treatment-related toxicities. Several prospective trials have shown primary retroperitoneal lymph node dissection (RPLND) to be effective and safe as an alternative treatment. These results made us change the guidelines in the latest update of the SWENOTECA treatment program making surgery with RPLND the primary treatment modality in seminoma stage IIA to IIB ≤ 3 cm with 1-2 metastatic nodes. We have done an update of the result of the patients treated by the new management program. METHODS: The RPLND surgery in Sweden and Norway are centralised to 5 hospitals all participating in this study. In the study we included both patients with recurrence after initial stage I disease and patients with stage IIA and B at diagnosis. The patients were operated between 2019 and 2022. We collected information on operation time, bleeding, peri- and postoperative complications. We also analysed the histology and if adjuvant chemotherapy was given. We followed the patients for any recurrence of disease. RESULTS: We have included 61 patients operated from January 2019 to September 2022. The number of operations per site varied from 4 to 22. The mean age of patients at time of RPLND was 42.6 years (range 25-79). 38 patients had stage I disease at diagnosis and a recurrence. 23 patients had stage IIA or IIB disease at diagnosis. At time of RPLND 46 patients had IIA-disease and 14 stage IIB-disease (one missing data). The histology from RPLND showed seminoma in 56 patients, necrosis in two patients, teratoma in one patient (two missing data). 24 patients were operated with robotic laparoscopic technique. Seven patients out of 61 had a Clavien-Dindo postoperative complication > 2. The patients have been followed for a median of 17 months (range 2-45). Five patients have had recurrences, three in operated template and two outside templates. CONCLUSIONS: Our early results of primary RPLND of seminomas IIA-IIB ≤ 3 cm, show promising results. Longer follow-up is required to fully ensure that this is a safe treatment option. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e451 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anna Thor More articles by this author Axel Gerdtsson More articles by this author Bjarte Almas More articles by this author Dag Halvorsen More articles by this author Gabriella Cohn Cedermark More articles by this author Helene Neegaard More articles by this author Ingrid Glimelius More articles by this author Hege Sagstuen Haugnes More articles by this author Asa Karlsdottir More articles by this author Olof Stahl More articles by this author Signe Melsen Larsen More articles by this author Anna Grenabo Bergdahl More articles by this author Torgrim Tandstad More articles by this author Anders Kjellman More articles by this author Expand All Advertisement PDF downloadLoading ...

Radiotherapy in Seminoma Stage I: the reports of its death are greatly exaggerated

Radiotherapy in Seminoma Stage I: the reports of its death are greatly exaggerated

The early results of the SWENOTECA (Swedish Norwegian Testicular Cancer Group) introduction of primary Retroperitoneal Lymph Node Dissection (RPLND) in seminoma stage IIA-IIb ≤ 3cm

The early results of the SWENOTECA (Swedish Norwegian Testicular Cancer Group) introduction of primary Retroperitoneal Lymph Node Dissection (RPLND) in seminoma stage IIA-IIb ≤ 3cm

Hypogonadism as a Risk Factor for Metabolic Syndrome and Vascular Diseases in Patients with Germ Cell Tumors of the Testis After Treatment

In the last few decades the rate of testicular germ cell tumors (TGCTs) has been increased worldwide. This type of neoplasia is one of the main causes of cancer mortality in young men. But in the case of correct management, rational chemotherapy (CT) regimens and timely diagnosis, almost 95% of patients can achieve full recovery. At the same time, there is an increased risk of side effects after CT, namely: infertility, hypogonadism, osteoporosis, cardiovascular diseases. Metabolic syndrome (MS) as a set of metabolic disorders based on hypertension, obesity, dyslipidemia, is associated with an increased risk of cardiovascular diseases. The objective: to determine the incidence of metabolic syndrome (MS) in patients with TGCTs in five or more years after initial treatment. Materials and methods. 68 patients with TGCTs 18-55 years old were examined. Unilateral high orchiectomy and follow-up observed management were performed in 14 patients, adjuvant chemotherapy for 1-2 cycles of PE (cisplatin + etoposide) or REВ (cisplatin + etoposide + bleocin) – in 22 persons, standard CT PE or REВ (<850 mg cisplatin) – 20 individuals, highdose CT for more than 4 cycles with the inclusion of cisplatin (total dose> 850 mg) – 12 patients. The control group included 29 men of the appropriate age. During the study we determined: total testosterone (T), luteinizing hormone (LH), follicle-stimulating hormone (FSH), high-density lipoprotein, triglycerides, glucose, waist circumference, blood pressure, body mass index (BMI). A comparative analysis of the results of treatment of all groups with the control group was performed. Results. The analysis of risk factors for MS in patients with TGCTs after CT performed the significantly higher levels of triglycerides, high-density lipoproteins, elevated BMI. At the same time, the level of T was reduced in patients with MS. Hypogonadism was found in 12 (22 %) patients after CT and in 1 (6 %) patient with seminoma stage I after unilateral orchiectomy. MS was detected in 3 (24 %) of 12 patients with hypogonadism and in 9 (22 %) of the 42 patients in the CT group. However, in the patients with TGCTs with hypogonadism after CT, higher BMI and lower T levels were determined. T levels were lower and LH and FSH were higher in patients who received CT compared with the persons control group. Conclusions. In the patients with testicular germ cell tumors with signs of hypogonadism there is a significantly higher risk of development of metabolic syndrome after chemotherapy. Such patients require long-term annual examination and monitoring of sex hormone levels.

Secondary cancer risk after radiotherapy of seminoma stage one

Background: In radiation treatment of stage one seminoma (SOS) induced secondary cancer in organs at risk (OARs), located in or out of the radiation fields, is a late toxicity of major concern. This study aimed to compare the secondary cancer risk in radiotherapy of SOS in two-dimensional conventional radiation therapy (2D) and three-dimensional conformal radiation therapy (3DCRT). Materials and Methods: CT scan images of 10 patients with SOS were used to design 2D conventional and 3D conformal treatment plans using 25 Gy in 20 sessions. The life attributable risk (LAR) of liver, stomach, and colon were calculated using the organ equivalent dose (OED) model for organs in radiation field and Biologic Effects of Ionizing Radiation VII (BEIR VII) model for organs out of field. Results: LAR of OARs in radiation field such as, liver and stomach was obtained 40% higher in the 2D treatment than in the 3D treatment, while as for the colon, it was 17% lower in the 2D treatment than in the 3D treatment. The LAR values of kidneys located outside the radiation field in the 2D treatment were calculated 0.04%. Conclusion: Increasing the prescribed dose (25 vs. 20) as well as the number of treatment sessions (20 vs. 10) resulted in increasing in the LAR of at-risk organs such as liver, stomach, colon. Therefore, estimating cancer risk of critical organs exposed to radiation through examining the effects of dose fractionation and prescribed doses can be used in optimizing of treatment plan for seminoma, selection of a better treatment method by oncologists, and patient follow-up.

LBA30 Single-dose carboplatin followed by involved-node radiotherapy as curative treatment for seminoma stage IIA/B: Efficacy results from the international multicenter phase II trial SAKK 01/10

Standard treatment options for patients (pts) with seminoma clinical stage (CS) IIA/B are either extensive “dog-leg” para-aortic/pelvic radiotherapy (RT) or 3-4 cycles of cisplatin-based combination chemotherapy (ChT) with a 3-year progression free survival (PFS) of ≥90%, but potential acute and late toxicities. SAKK 01/10 is a trial of the Swiss Group for Clinical Cancer Research (SAKK) and the German Testicular Cancer Study Group (GTCSG) aiming at reducing therapy toxicity while preserving efficacy in CS IIA/B seminoma by combining deescalated ChT and RT.

Clinical implications of the American Joint Committee on Cancer (AJCC) 8th edition update in seminoma pT1 subclassification

BackgroundSeminoma accounts for 30–50% of testicular germ cell tumors (TGCT)—the most common solid malignancy in men aged 15–35 years. The American Joint Committee on Cancer (AJCC) 8th edition (2018) created the subclassifications pT1a (tumor size < 3 cm) and pT1b (≥ 3 cm), despite not being universally recognized. Rete testis invasion (RTI) and tumor size > 4 cm are considered features associated with a higher recurrence risk, but not formally used for staging. The authors propose further understanding the subclassification’s potential impact in clinical practice, by summarizing current evidence and reviewing clinical cases in their institutions.MethodsAll consecutive cases of seminoma stage I, pT1 treated in two institutions between January 2005 and December 2016 were included. Clinical data were retrieved, and variables were analyzed using SPSS. Relevant literature on the topic was reviewed.ResultsSeminoma pT1 was identified in 58 patients. By using newly AJCC criteria, 29 (50%) would have been staged as pT1a and 29 (50%) pT1b. Median age at diagnosis was similar (33 in pT1a vs 32 in pT1b). Median follow-up time 5.8 years. Almost half (45%) of pT1b patients had a tumor size < 4 cm. The majority of either pT1a or pT1b were treated with chemotherapy or radiotherapy, reflecting more intensive approaches in the past. Three retroperitoneal recurrences were recorded (two in pT1a, one in pT1b, all under surveillance protocol); no deaths occurred. RTI and extensive necrosis (EN) were associated with pT1b (P < 0.0001 and P = 0.023, respectively), known adverse biological features.ConclusionsIn our population, the exploratory analysis of the newly created AJCC criteria showed no significant difference in recurrence or death, although pT1b was associated with adverse biomarkers, such as RTI and EN, but its clinical relevance remains incompletely understood. Our results confirm an excellent prognosis, regardless of subcategorization, thus a larger population and a longer follow-up time are needed to understand prospectively the impact of the recently updated criteria. We would recommend using the latest AJCC staging system, although the individual risk of relapse, long-term toxicities and patient preferences should be taken into account when considering surveillance or active treatment adjuvant options.

Prognostic Role of Early Interim Fluorodeoxyglucose Positron Emission Tomography in Patients With Advanced Seminoma Undergoing Standard Treatment.

Patients with advanced seminoma have an exceedingly favorable prognosis. Studies aiming to reduce the total treatment burden and side effects in patients with well-defined disease and very good prognosis are warranted. In a prospective observational study, patients with advanced stage seminoma were treated with bleomycin, etoposide, and cisplatin (BEP) or EP according to guidelines. Fluorodeoxyglucose with positron emission tomography and computed tomography (FDG-PET/CT) examinations were performed at baseline, after 2 cycles (PET/CT2) in all patients, and after chemotherapy at the physician's discretion. Disease response to treatment assessed by PET/CT was qualitatively evaluated by 2 independent nuclear medicine physicians. Contrast-enhanced CT scans were also performed according to guidelines (at baseline, after treatment, during follow-up). The study's primary endpoint was to evaluate the association between PET/CT2 findings and relapse-free survival. From January 2009 to January 2017, a total of 75 consecutive patients were enrolled, of whom 70 were included for analysis. The clinical disease stage was IIA-B and IIC-III in 40% and 60%, respectively. By local assessment, 46 PET/CT2 scans (65.7%) were reported as negative, and 46% of these patients had stage IIC-III disease. Five-year relapse-free survival of PET/CT2-positive patients was 75% (95% confidence interval, 60-95) compared to 97.8% (95% confidence interval, 93.7-100) of PET/CT2-negative patients (P= .002). In univariate analyses, PET/CT2 was significantly associated with relapse-free survival (P= .02). No residual FDG uptake after 2 cycles of conventional chemotherapy is prognostic in advanced seminoma, but it may be useful to optimize the standard prognostic risk groups and may be tested within larger prospective clinical trials of chemotherapy deescalation.

SUN-040 Hormone Replacement Therapy in Transgender Unmasks Testicular Tumor

Introduction In transwomen, hormonal replacement therapy typically usually consists of anti-androgen and/or estrogens. Per Endocrine Society 2017 guidelines, patients should be evaluated every 3 months in the first year for appropriate signs of feminization and adverse reactions. This includes measuring serum testosterone every 3 months initially and the testosterone level should be < 50 ng/dL. We describe a case of a transwoman patient diagnosed with testicular seminoma during surveillance of hormonal replacement therapy (HRT). Case presentation A 31-year-old male-to-female transgender presents to the endocrine clinic for HRT. She previously had seen another provider for HRT and was started on estradiol valerate 5 mg weekly and leuprolide 3.75 mg every month. After 5 months of therapy, she reported that her testosterone level remained elevated, so spironolactone 100 mg BID was subsequently added. Despite adherence, she was dismayed at how little physical changes she achieved after 1.5 years of HRT. She denies taking exogenous substances or OTC mediation containing androgens. Her examination reveals a male habitus and musculature with male voice, male diamond pubic hair pattern, adult penis size and scrotum measuring 20 cc’s bilaterally. Initial labs revealed total testosterone 131 ng/dl, free testosterone 30.8 ng/dl, bioavailable testosterone 64.6 ng/dl, SHBG 12 nmol/L, LH < 0.07 IU/L, FSH < 0.1 IU/L, and estradiol 146 pg/ml. Due to non-suppressed testosterone level despite undetectable gonadotropins, adrenal androgen labs were obtained which was normal. However, her HCG-beta tumor marker was elevated, 12 IU/L (0-3). This prompted a scrotal ultrasound which revealed 3.2 cm right testis mass. Follow-up PET/CT revealed increased activity localized to the right testis without findings of metastasis. Patient underwent right orchiectomy with pathology revealing seminoma stage 1A pT1bMx. At 2 months postop, her total testosterone is now 8 ng/dl, and she reports that her breast tissue has increased and skin softened. Conclusion Hyperandrogenism can be easily diagnosed in females given more obvious clinical features; however, except for precocious puberty, there are typically no obvious features of exogenous testosterone production in males. Thus, typically no workup is undertaken in males to look for underlying cause, including testicular cancer. While presence of scrotal mass is the most common initial presentation, patients can be asymptomatic until tumor burden is high and there is metastasis. Transwomen should be monitored by obtaining estradiol and testosterone levels following the Endocrine Society guidelines. If patient is on GnRH agonist, her testosterone level should be almost completely suppressed (T <50). A testosterone level > 50 ng/dL while on GnRH therapy should warrant workup for exogenous sources, including testicular cancer and adrenal abnormalities.

MP76-02 SINGLE INSTITUTION EXPERIENCE WITH PRIMARY RPLND FOR LOW-STAGE SEMINOMA

INTRODUCTION AND OBJECTIVE:Low stage seminoma of the testis with suspected retroperitoneal lymph nodes metastases has traditionally been managed with primary chemotherapy or radiation therapy with ...

Contemporary management of early stage testicular seminoma.

Therapy for early stage testicular seminoma has changed radically over the past several decades. Given high cure rates and clinical trials supporting less active therapy in most cases, close observation after radical orchiectomy is now considered standard of care for clinical stage (CS) IA/IB seminoma, with either radiation therapy (RT) or chemotherapy salvage options possible. For CS IIA/IIB seminoma characterized by non-bulky retroperitoneal lymph node involvement (≤5 cm in greatest dimension), RT or combination chemotherapy are the standard of care. Given high comparable survival rates, preventing treatment-related toxicity and second malignancy, and limiting quality of life deficits associated with intense treatment has gained much greater importance. Clinical trials are currently testing the feasibility of retroperitoneal lymph node dissection (RPLND) for low volume CS IIA/IIB metastatic testicular seminoma to this end. Likewise, one cycle of chemotherapy is being evaluated as an adjuvant approach to reduce recurrence rates in CS I disease with unfavorable risk factors. Moreover, recent genomic and molecular studies have recently identified novel signatures and a potential biomarker for testicular seminoma. In this review, we first summarize the evolution of early stage seminoma management and discuss the effectiveness and drawbacks of contemporary treatment strategies. We further outline future perspectives and potential challenges in management of early stage testicular seminoma.

Trends in incidence, mortality and survival of testicular cancer patients in Belarus.

IntroductionThe objective of this study was to assess recent trends in incidence, mortality and relative survival (RS) in testicular cancer (TC) patients in Belarus and to provide international comparisons of our figures.Material and methodsWe surveyed the Belarusian Cancer Registry for all male cases diagnosed with International Classification of Diseases for Oncology, third edition (ICD-O-3) topography code C62 between 1990 and 2015. Trends for incidence and mortality rates per 100,000 of the world standard population and annual percentage changes (APCs) were calculated. We also estimated the 1- and 5-year RS rates for the 1990–1998, 1999–2007 and 2008–2015 periods according to the Ederer II method. The RS estimates for the 2008–2015 period were age-standardized and compared with the published EUROCARE-5 data and SEER-18 database analysis.ResultsA total of 2,500 and 2,439 cases were included into incidence and survival analyses, respectively. We found a significant increase in the TC age-standardized incidence rate (APC 2.6%) and a decline in the age-standardized mortality (APC -3.0%) over the study period. RS significantly increased in all patients` strata; a relative increase was more pronounced in advanced stages of seminoma and younger age groups. Nevertheless, the most recent figures of age-standardized RS including stage-specific estimates were generally worse than the European and SEER data.ConclusionsWe have found a significant increase in TC incidence in Belarus in recent years. Mortality has significantly declined with a corresponding increase in RS which, however, did not reach European or North American figures. Continued effort is required to improve the quality of management of TC patients in our country.

Carboplatin dose based on actual renal function: no excess of acute haematotoxicity in adjuvant treatment in seminoma stage I

IntroductionThe practice of carboplatin dosing is not concordant among different centres and oncologists. Some clinical guidelines recommend capping of the carboplatin dose at, for example, creatinine-clearance (Crea-Cl) of 125 mL/min because of concerns of excessive toxicity. Clinical data to support such recommendations are lacking, especially in patients with seminoma.MethodsThis is a retrospective analysis of acute haematotoxicity of patients with stage I seminoma treated with adjuvant carboplatin area under the curve (AUC) 7 in routine practice in two Swiss centres in 2005–2015, and a comparison of incidence and grade (according to Common Terminology Criteria for Adverse Events v4.0) of haematological adverse events (hAEs) in patients with Crea-Cl <125 mL/min vs >125 mL/min without dose capping.Results74 patients with 229 documented measurements were included (median 3/patient). A total of 151 hAEs occurred. Platelet nadir occurred earlier than median white cell/neutrophil count (median day 15 vs day 22; P<0.0001). The majority of hAEs were mild, with more than 80% being of grade 1. Only two (2.7%) clinically relevant hAEs necessitating subsequent interventions occurred (one patient received platelet transfusion, one patient with febrile neutropaenia). Haematological toxicities were not statistically different in patients dosed with Crea-Cl >125 mL/min versus those with Crea-Cl <125 mL/min. No hAEs other than grade 1 occurred before day 10 and after day 24.ConclusionsToxicity after single-dose carboplatin AUC 7 is generally mild. No excess of toxicity occurs in patients with high Crea-Cl above 125 mL/min, and therefore dose capping is not routinely necessary. In addition, this study provides a rationale for efficient use of healthcare services without compromising patients’ safety.

The Use of Chemotherapy Instead of Radiation Therapy Does Not Reduce the Incidence of Second Cancers in Survivors of Early Stage Seminoma: A Population-Based Study from British Columbia

The Use of Chemotherapy Instead of Radiation Therapy Does Not Reduce the Incidence of Second Cancers in Survivors of Early Stage Seminoma: A Population-Based Study from British Columbia

Impact of modern treatment strategies on second cancer incidence for patients with early stage seminoma: A population-based study in British Columbia.

423 Background: The purpose of this study is to examine the incidence of Second Cancers (SC) in patients with Stage I or II Seminoma treated in British Columbia (BC), and compare rates between patients managed with Radiation Therapy, Chemotherapy, or Active Surveillance. Methods: Consecutive patients with Stage I or II Seminoma (n = 1549, 21167 person years) diagnosed in British Columbia between 1984 and 2013 were identified from the BC Cancer Registry and included in this study. Patients were managed with Radiation Therapy (RT; n = 663), Chemotherapy (CT; n = 259) or Active Surveillance (AS; n = 624). Data was extracted from the registry and verified by individual patient chart review. Cumulative incidence rates were computed using competing risk analysis. Age and Sex Standardized Incidence Ratios (ASIR) were calculated (compared to the Canadian population). Results: After a median follow-up of 14 years (RT group: 21.5yrs, CT group: 10yrs, AS group: 8yrs), the 15 year Overall Survival was 91.4%. Only 15 patients died from progressive Seminoma, while 46 died from second cancers. A total of 115 patients developed SCs, and the cumulative incidence (CI) of SC, at 15 years, was: 5.9% for patients who received RT, 8.6% for those who had CT, and 4.9% for patients managed with AS. The higher CI for patients treated with CT, versus RT, was not statistically significant (p = 0.08). The ASIR for RT, CT and AS groups were 1.31 (95% Confidence Intervals: 0.92- 1.86), 2.57 (1.07- 6.15; p = 0.03), and 1.38 (0.75- 2.54), respectively. Patients who underwent treatment at ages 30-44yr and 45-59yr had a significantly higher ASIRs of 4.33 (2.1- 8.9; p &lt; 0.001) and 1.8 (1.16- 2.8; p = 0.008). ASIR was not significantly different when stratified by radiation dose, field types, or year of diagnosis. Conclusions: We found no statistically significant difference in the Cumulative Incidence of Second Cancers for patients treated with Radiation Therapy versus Chemotherapy in our patient population. Longer follow-up for the CT group is required to confirm trends evident in our analysis.

Change of spermogram parameters and levels of FSH in patients with seminoma stage I after adjuvant carboplatin

Given the fact that the germ cell tumors diagnosed in young men of reproductive age (more than half of them are seminomas), the study of the adverse effect of chemotherapy on fertility is an important task. In 18 patients in the I stage of seminoma estimated sperm and FSH lev els prior to the orchidectomy, before chemotherapy with carboplatin and after 1 and 2 years after treatment. Revealed little impact on sperm after adjuvant treatment – after 2 years we watched improved of semen parameters, while reducing the level of FSH. There were no sta tistically significant differences in sperm before and after the orchidec tomy that can be explained by the negative impact of TIN on sper matogenesis in the peritumoral tissue.

Relapse and gastrointestinal toxicity associated with radiotherapy treatment in stage I seminoma patients

BackgroundThe results preceding this study documented that patients with early stage classical seminoma treated with radiotherapy in the Hospital General de Mexico, using doses of 30Gy in 15 fractions using the modified dog-leg technique have lower gastrointestinal toxicity than the conventional dog-leg technique, but with no difference in overall survival and disease-free survival, both resulting in 100% 60 month-survival. ObjectiveTo determine the results of treatment in terms of relapse and gastrointestinal toxicity, comparing radiotherapy with conventional dog-leg, modified dog-leg and inverted-Y techniques. Material and methodsretrospective, observational, comparative, analytical, retrolective study; 40 patients were analysed, all diagnosed with stage I seminoma treated at the RT Hospital General de Mexico between October 2009 and May 2016. ResultsThe age of the patients was 33±8 years; 32 (80%) were treated in Accelerator linear and 8 patients (20%) in cobalt-60. The modified dog-leg technique was used in 24 patients (60%), conventional dog-leg technique in 12 patients (30%), and inverted-Y technique in 4 patients (10%). The radiation dose in 87% of patients was 25.2Gy. The most commonly found acute gastrointestinal toxicity was grade 2, present in 22% with modified dog-leg technique, 13% conventional dog-leg technique, and 3% for the inverted-Y technique (p=0.95). There was one relapse associated with the modified dog-leg technique; predicting factors for relapse including rete testis invasion, trans-scrotal violation, and lymphovascular invasion had no statistically significant impact. ConclusionsRadiotherapy continues to be the treatment of choice in patients with early stage seminoma, with a low probability of relapse and acceptable gastrointestinal toxicity. There is no difference in relapse or gastrointestinal toxicity associated with the different radiation techniques in patients with stage I seminoma, therefore the modified dog-leg technique is recommended as the field of irradiation is already reduced without a negative impact on relapse.

835P - Carboplatin dose based on actual renal function vs. dose capping: no excess of hematotoxicity in treatment of seminoma stage I

835P - Carboplatin dose based on actual renal function vs. dose capping: no excess of hematotoxicity in treatment of seminoma stage I

ACR Appropriateness Criteria Staging of Testicular Malignancy

Testicular cancer represents only 1% of all malignancies occurring in men. However, it is the most frequent malignancy in men between the ages of 20 and 34 years, accounting for 10% to 14% of cancer incidence in that age group. In most instances, the diagnosis of testicular tumors is established with a carefully performed physical examination and scrotal ultrasonography. Tumor markers are useful for determining the presence of residual disease. Cross-sectional imaging studies (CT, MRI) are useful in determining the location of metastases. Chest radiography and CT are used to assess pulmonary disease. Fluorine-18-2-fluoro-2-deoxy-d-glucose (FDG) PET scans have slightly higher sensitivity than CT, but their role in staging testicular cancer has not been determined in a large study. FDG PET may play a role in the follow-up of higher stage seminoma after chemotherapy. Bone scans are useful in the absence of FDG PET scans and should be used when bone metastases are suspected.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.