title: Interdisciplinary evidence-based recommendations for the follow-up of early stage seminomatous testicular germ cell cancer patients.
abstract: OBJECTIVE
  To provide guidance regarding follow-up procedures after initial treatment of early stage testicular seminoma (clinical stages (CS) I-II A/B) based on current published evidence complemented by expert opinion.
  
  
  METHODS
  An interdisciplinary, multinational working group consisting of urologists, medical oncologists, and radiation oncologists analyzed the published evidence regarding follow-up procedures in various stages of seminomatous and nonseminomatous testicular cancers. Focusing on radiooncological aspects, the recommendations contained herein are restricted to early stage seminoma (with radiotherapy being a standard treatment option). In particular, extent, frequency, and duration of imaging at follow-up were analyzed concerning relapse patterns, risk factors, and mode of relapse detection.
  
  
  RESULTS
  Active surveillance, adjuvant carboplatin or radiotherapy are equally accepted options for CS I seminoma but they result in different relapse rates and patterns. Usually relapses occur within the first 2(-6) years. Routinely performed follow-up using computerized tomography (CT) after adjuvant treatment yield only low detection rates of recurrences. Therefore, there is no evidence to maintain routine examinations every 3-4 months. After treatment of stage IIA/B, detection rates of relapses or progression identified solely by routinely performed CT during follow-up are low.
  
  
  CONCLUSIONS
  Considering lifelong cure rates of up to 99% for patients treated for seminoma CS I-IIA/B, the negative impact of unnecessary ionizing radiation exposure has to be considered. The presented recommendations for various follow-up scenarios for early stage seminoma strongly promote the restrictive use of imaging procedures that utilize ionizing radiation (especially CT), due to its potential to induce secondary malignancies.
authors.affiliation: Department of Radiation Oncology, University Hospital, Tübingen, Germany. rainer.souchon@med.uni-tuebingen.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Souchon
authors.forename: Michael
authors.initials: M
authors.lastname: Hartmann
authors.forename: Susanne
authors.initials: S
authors.lastname: Krege
authors.forename: Anja
authors.initials: A
authors.lastname: Lorch
authors.forename: Frank
authors.initials: F
authors.lastname: Mayer
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.forename: Silke
authors.initials: S
authors.lastname: Gillessen
authors.forename: Jörg
authors.initials: J
authors.lastname: Beyer
authors.forename: Richard
authors.initials: R
authors.lastname: Cathomas
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D019091:Critical Pathways; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D033183:Interdisciplinary Communication; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000209:etiology; D010348:Patient Care Team; D049268:Positron-Emission Tomography / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant; D018239:Seminoma / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects; D014463:Ultrasonography
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin