Treatment/Prognosis Flashcards
Per NCCN, what is the Tx of stage I good- or intermediate-risk NSGCT?
The Tx of stage I good- or intermediate-risk NSGCT is observation after orchiectomy (preferred for stage IA) if compliant vs. nerve-sparing RPLND vs. bleomycin/etoposide/cisplatin (BEP) chemo × 1 to 2 cycles (stage IB only).
What is the risk of relapse after orchiectomy alone for stage I good- or intermediate-risk NSGCT if tumor markers are normal postoperatively?
The risk of relapse after orchiectomy alone for stage I good- or intermediate-risk NSGCT if tumor markers are normal postoperatively is ∼30%.
Per NCCN, how should pts with stage I NSGCT be monitored in an observation protocol?
Observation in pts with stage I NSGCT should consist of visits, tumor markers and CXR q2 mos for yr 1, q3 mos for yr 2, q4–6 mos for yrs 3–4, then annually in yr 5. CT A/P should be done q4–6 mos for yrs 1–2, then q6 mos to annually for yrs 3–4.
What did the MRC trial TE08 show for pts with stage I NSGCT?
MRC TE08 randomized 414 pts with stage I NSGCT s/p orchiectomy with normal serum markers (10% high risk with LVI) to CT chest/abdomen at 3 and 12 mos vs. CT scans at 3, 6, 9, 12, and 24 mos. At median follow-up of 3.3 yrs, 2-yr RFS was 79% with 2 scans vs. 84% with 5 scans (NSS). The 1st indication of relapse was markers in 39% and CT abdomen in 39%. The conclusion is that CT scans at 3 and 12 mos after orchiectomy might be reasonable in low-risk pts and that chest CT may be unnecessary. (Rustin GJ et al., JCO 2007)
What is the chance of positive nodes on RPLND despite a negative CT scan in pts with stage I NSGCT?
The risk of positive nodes on RPLND despite negative CT scan in pts with stage I NSGCT is 30%.
What is the relapse rate in pts with stage I NSGCT after orchiectomy → RPLND?
The relapse rate in pts with stage I NSGCT after orchiectomy → RPLND is 5%–10%, most commonly to the lungs.
Per NCCN, how should pts with NSGCT and persistently positive tumor markers after orchiectomy be treated?
Pts with NSGCT and persistently positive tumor markers after orchiectomy should be treated with either BEP × 3 cycles or cisplatin/etoposide (EP) × 4 cycles.
What did the German Testicular Study Group AUO trial AH 01/94 show for pts with stage I NSGCT?
The AUO AH 01/94 trial randomized 382 pts with clinical stage I NSGCT to RPLND vs. BEP × 1 cycle. At median f/u of 4.7 yrs, 2-yr RFS was 92% with Sg and 99% with BEP (HR 7.9, SS). The authors concluded that 1 course of BEP is sup to RPLND in clinical stage I Dz (Albers P et al., JCO 2008). Some question the quality of RPLND in this study.
Per NCCN, how should pts with stage II NSGCT with a +node diagnosed only after RPLND be treated?
pN1 (1–5 nodes <2 cm) may be observed (preferred) or offered 2 cycles of BEP or EP chemo. pN2 (ENE or any number of nodes <5 cm) chemo is preferred over surveillance. pN3 (any number of nodes >5 cm) should rcv 3 cycles of BEP or 4 cycles of EP. Node should be observed.
Per NCCN, what is the Tx of pts with bulky stage II or III NSGCT?
Pts with bulky stage II or III NSGCT should be treated with either BEP × 3 cycles or EP × 4 cycles (good risk) or BEP × 4 cycles (intermediate risk).
What is the role of RT in the primary Tx of NSGCT?
Although RT may be used for palliation of metastatic Dz, there is no established role for RT in the primary Tx of NSGCT.
Per NCCN, what is the f/u for pts with NSGCT with CR to chemo and/or RPLND?
Surveillance of pts with NSGCT after CR to chemo and/or RPLND should consist of visits and tumor markers q2–3 mos for yrs 1–2, q6 mos for yrs 3–4, then annually in yr 5. CXR should be done q6 mos for yrs 1–2, then annually. CT A/P should be done q6 mos for yr 1, then annually for yr 2, then as clinically indicated.
