How safe is surveillance in patients with histologically low-risk non-seminomatous testicular cancer in a geographically extended country with limited computerised tomographic resources?
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.
Fosså
S D
SD
Department of Medical Oncology, Norwegian Radium Hospital, Oslo.
Jacobsen
A B
AB
Aass
N
N
Heilo
A
A
Stenwig
A E
AE
Kummen
O
O
Johannessen
N B
NB
Waaler
G
G
Ogreid
P
P
Borge
L
L
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
D014408:Biomarkers, Tumor