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Randomized Trial Of Two Or Five Computed Tomography Scans In The Surveillance Of Patients With Stage I Nonseminomatous Germ Cell Tumors Of The Testis

August 05, 2017

UroToday- Select patients with stage I non-seminomatous germ cell tumors without lymphovascular invasion and with a low percentage of embryonal carcinoma are commonly followed expectantly due to their low incidence of recurrence. In most institutions, recommendations for surveillance include monthly history and physical examinations, serum tumor markers, and CXR and five abdominopelvic CT scans in the first year. Some have suggested that this intensive schedule may expose patients to high levels of radiation at a high financial cost.

In the April 10th issue of the JCO, Rustin and colleagues report on a Medical Research Council randomized trial designed to evaluate the difference in tumor surveillance between two or five CT scans in the surveillance of patients with stage I mixed germ cell tumors.

Over 400 patients with stage I mixed germ cell tumors who opted for surveillance were randomized into 2 groups: (1) chest and abdominal CT scan at 3 and 12 months, and (2) chest and abdominal CT scans at 3, 6, 9, 12, and 24 months. Patients were seen at the same time intervals for serum tumor markers and physical examinations.

After a median follow-up of 40 months, recurrences were identified in 15% of patients in the 2 scan group (37/247) and 20% of patients in the 5 scan group (33/167). No patients recurred with high-risk disease, and only 3 patients recurred with intermediate risk disease (2 in the two-scan group and 1 in the 5-scan group). No patients died of disease.

These data from a randomized trial suggest that patients with low-risk stage I testicular tumors who choose surveillance are not at an increased risk of developing high-risk recurrences if CT scans are only performed twice in the first year. However, perhaps the sensitivity of surveillance may be maximized (and radiation exposure minimized) if chest radiographs are performed instead of chest CT scans, allowing for abdominopelvic CT scans to be performed more frequently than twice a year.

Gordon J. Rustin, Graham M. Mead, Sally P. Stenning, Paul A. Vasey, Nina Aass, Robert A. Huddart, Michael P. Sokal, Jonathan K. Joffe, Stephen J. Harland, and Sarah J. Kirk

J Clin Oncol. 2007 Apr 10; 25(11):1310-5
Reviewed by UroToday Contributing Editor Ricardo F. Sánchez-Ortiz, MD

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