title: How safe is surveillance in patients with histologically low-risk non-seminomatous testicular cancer in a geographically extended country with limited computerised tomographic resources?
abstract: In patients with clinical stage I non-seminomatous testicular cancer only limited information is available about the administrative problems with the surveillance programme, in particular if this policy is to be implemented in a geographically extended country with limited computerised tomography (CT) resources. One hundred and two patients with non-seminomatous testicular cancer clinical stage I and low-risk histology (MRC criteria, UK) were followed by the surveillance policy for at least 1 year after orchiectomy (median 47 months, range 21-81 months). Twenty-two patients (22%) relapsed after a median time of 5 months (range 2-18 months), 14 of them in the retroperitoneal space. Serum alpha-fetoprotein and/or human chorionic gonadotrophin were elevated in eight of the 22 relapsing patients. The progression-free and cancer-corrected survival rates were 78% and 99% respectively. Patient non-compliance did not represent a major problem, whereas the regular and adequate performance of necessary CT examinations yielded some administrative difficulties. One and 3 years after orchiectomy about 50% of the relapse-free patients had no psychological problems and were satisfied with the surveillance programme, whereas 46% reported minor and 4% major psychological distress. Despite non-negligible administrative difficulties in geographically extended countries, surveillance is feasible and safe in compliant patients with low-risk non-seminomatous testicular cancer stage I. The responsible cancer centre and the local hospitals should establish a high degree of cooperation and enable adequate follow-up examinations in these patients.
authors.affiliation: Department of Medical Oncology, Norwegian Radium Hospital, Oslo.
authors.forename: S D
authors.initials: SD
authors.lastname: Fosså
authors.forename: A B
authors.initials: AB
authors.lastname: Jacobsen
authors.forename: N
authors.initials: N
authors.lastname: Aass
authors.forename: A
authors.initials: A
authors.lastname: Heilo
authors.forename: A E
authors.initials: AE
authors.lastname: Stenwig
authors.forename: O
authors.initials: O
authors.lastname: Kummen
authors.forename: N B
authors.initials: NB
authors.lastname: Johannessen
authors.forename: G
authors.initials: G
authors.lastname: Waaler
authors.forename: P
authors.initials: P
authors.lastname: Ogreid
authors.forename: L
authors.initials: L
authors.lastname: Borge
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009664:Norway; D009919:Orchiectomy; D010349:Patient Compliance; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
chemical_list: D014408:Biomarkers, Tumor