Posttreatment surveillance after paraaortic radiotherapy for stage I seminoma: a systematic analysis.
BACKGROUND
The extent and duration of routine follow-up after paraaortic (PA) radiotherapy for stage I seminoma remain controversial in terms of efficacy, costs of technical investigations and long-term morbidity.


OBJECTIVE
To analyze the current literature assessing routine follow-up after PA radiotherapy for stage I seminoma.


METHODS
We identified all published reports on PA radiotherapy for stage I seminoma (1986-2005). We analyzed time patterns of recurrence, sites and methods of detection of relapse, and follow-up programs used.


RESULTS
We identified 11 publications reporting outcome in 2,280 patients. Median time to recurrence in 80 relapsing patients was 15.5 months. Less than 10% of recurrences were diagnosed beyond the third year of follow-up. Isolated locoregional or distant recurrence was observed in 52 and 20 patients, respectively, without significant difference in median time to relapse. 19 out of 43 recurrences with reported method of detection of relapse were diagnosed by routine technical investigations. There was no significant difference in time to relapse between those patients followed with low volume as compared to high-volume imaging protocols.


CONCLUSIONS
Our data suggest that technical investigations in posttreatment surveillance should be restricted to the first 3 years of follow-up. Furthermore, surveillance programs with a high volume of imaging apparently do not lead to earlier detection or less advanced stage at the time of relapse as compared to protocols with low volume imaging.
Classen
Johannes
J
Department of Radiation Oncology, Tübingen University Hospital, Hoppe-Seyler-Str. 3, 72079, Tübingen, Germany. johannes.classen@vincentius-ka.de
Souchon
Rainer
R
Hehr
Thomas
T
Hartmann
Michael
M
Hartmann
Jörg T
JT
Bamberg
Michael
M
D001011:Aorta; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods; D011879:Radiotherapy Dosage; D018239:Seminoma / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000532:radiotherapy* / Q000556:secondary; D013736:Testicular Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
Eur Urol. 2008 Mar;53(3):497-513
18191015
World J Urol. 2004 Oct;22(4):235-43
15448994
Int J Radiat Oncol Biol Phys. 2005 Mar 1;61(3):741-4
15708252
Clin Oncol (R Coll Radiol). 1992 May;4(3):165-70
1586633
J Cancer Res Clin Oncol. 2001 Aug;127(8):475-81
11501746
J Clin Oncol. 1999 Apr;17(4):1146
10561173
Int J Urol. 2002 Mar;9(3):154-60; discussion 160-1
12010325
Clin Oncol (R Coll Radiol). 1993;5(6):364-6
8305356
Cancer. 1998 Mar 15;82(6):1126-33
9506359
Strahlenther Onkol. 1986 Dec;162(12):735-41
3810465
J Clin Oncol. 2005 Feb 20;23(6):1200-8
15718317
J Clin Oncol. 1996 Nov;14(11):2933-9
8918490
Ann Oncol. 2002 Feb;13(2):237-42
11886000
Strahlenther Onkol. 1999 Jul;175(7):320-4
10432993
Int J Radiat Oncol Biol Phys. 2003 Dec 1;57(5):1304-9
14630266
Int J Cancer. 1999 Dec 10;83(6):823-7
10597202
Eur Urol. 2005 Dec;48(6):885-94
16126333
Acta Oncol. 2005;44(2):142-8
15788293
Int J Radiat Oncol Biol Phys. 1998 Jan 15;40(2):455-9
9457835
Br J Cancer. 2004 Jun 14;90(12):2305-11
15150576
Clin Radiol. 2001 Feb;56(2):116-9
11222068
Strahlenther Onkol. 2009 Jun;185(6):349-54
19506817
Int J Radiat Oncol Biol Phys. 1996 May 1;35(2):293-8
8635936
Cancer. 2000 Jan 1;88(1):162-8
10618619
Lancet. 2005 Jul 23-29;366(9482):293-300
16039331
Eur Urol. 2008 Mar;53(3):478-96
18191324
Drugs. 2006;66(5):641-59
16620142
Clin Oncol (R Coll Radiol). 2001;13(4):296-300
11554630
Anticancer Res. 2001 Jul-Aug;21(4B):2989-93
11712799
Radiother Oncol. 1995 Nov;37(2):164-6
8747942