Testis Tümöründe Cerrahi Sonrası Takip-Tedavi
Özet
Testis tümörlerinde cerrahi sonrası takip protokolü, seminomatöz ve non-seminomatöz histopatolojik tanılara, tümörün evresine ve alınan tedaviye göre şekillenmektedir. Evre 1 seminomatöz tümörlerde orşiektomi sonrası izlem, adjuvan kemoterapi (karboplatin) ve radyoterapi seçenekleri mevcuttur; nükslerin çoğu ilk 2 yılda retroperitoneal lenf nodlarında saptanır ve takipler en az 5 yıl sürmelidir. Görüntülemede bilgisayarlı tomografi (BT) ve manyetik rezonans (MR) tercih edilmekle birlikte, BT'nin sekonder malignite riski bulunmakta, takiplere 5. yıldan sonra rutin görüntüleme önerilmemektedir. Evre 1 non-seminomatöz tümörlerde ise 5 yıllık nüks oranı %30 olup, bunların %90'ı ilk yılda ve çoğunlukla retroperitonda geliştiğinden çok sıkı bir izlem protokolü, Retroperitoneal Lenf Nodu Diseksiyonu (RPLND) veya 1 kür BEP adjuvan kemoterapisi uygulanır. Takip şemalarında tümör belirteçleri, abdominopelvik BT/MR ve akciğer grafisi/toraks tomografisi belirli periyotlarla (1., 2., 3., 4-5. yıllar) kullanılır; lenfovaskuler invazyon varlığı, adjuvan tedavi alımı veya tam remisyon sağlanamaması gibi durumlarda süreçler hastaya özel olarak sıkılaştırılıp modifiye edilir.
Post-surgical follow-up protocols for testicular tumors are shaped based on seminomatous and non-seminomatous histopathological diagnoses, tumor stage, and received treatments. For Stage 1 seminomatous tumors, surveillance, adjuvant chemotherapy (carboplatin), and radiotherapy are options after orchiectomy; most relapses occur within the first 2 years in retroperitoneal lymph nodes, and follow-up must continue for at least 5 years. Computed tomography (CT) and magnetic resonance (MR) are utilized for imaging, but due to CT's secondary malignancy risks, routine imaging is not recommended after 5 years. In Stage 1 non-seminomatous tumors, the 5-year relapse rate is approximately 30%, with 90% occurring in the first year mostly in the retroperitoneum, requiring strict surveillance, Retroperitoneal Lymph Node Dissection (RPLND), or 1 course of BEP adjuvant chemotherapy. Follow-up schedules utilize tumor markers, abdominopelvic CT/MR, and chest X-ray/thoracic CT at specific intervals (years 1, 2, 3, 4-5); these protocols are strictly modified and tailored individually in the presence of lymphovascular invasion, adjuvant therapy, or when complete remission is not achieved.
Referanslar
J Oldenburg , G C Alfsen, H Waehre, S D Fossa. Late recurrences of germ cell malignancies: a population-based experience over three decades. Br J Cancer, 2006;94:820.
Graham R Hale, Seth Teplitsky , Hong Truong et al. Lymph node imaging in testicular cancer. Transl Androl Urol, 2018;7:864 doi: 10.21037
S A Sohaib, D M Koh, Y Barbachano et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol, 2009;64:362.
G J Loughrey, B M Carrington, H Andersonet al. The value of specialist oncological radiology review of cross-sectional imaging. Clin Radiol, 1999;54:149.
Peter Chung , Gedske Daugaard, Scott Tyldesleyet al. Evaluation of a prognostic model for risk of relapse in stage I seminoma surveillance. Cancer Med, 2015;4:155. DOI: 10.1002/cam4.324
T Tandstad, O Stahl, O Dahl et al. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol, 2016;27:1299.
J Aparicio, X García del Muro, P Marotoet al. Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol, 2003;4: 867.
Madhur Nayan, Michael A S Jewett, Ali Hosni et al. Conditional Risk of Relapse in Surveillance for Clinical Stage I Testicular Cancer. Eur Urol, 2017;71:120. DOI: 10.1016/j.eururo.2016.07.013
Torgrim Tandstad, Rune Smaaland, Arne Solberget al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group. J Clin Oncol, 2011;29:719.
Stephenson, AJ, Neoplasms of the Testis. In: Campbell-Walsh Urology, Tenth Edition, Eds: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA. p 837- 900. (Elsevier, Philadelphia, PA, USA, 2012).
Albers P, Siener R, Krege S, et al. German Testicular Cancer Study Group. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of cli- nical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol 2008;26:2966-72
NCCN Testicular cancer Guideline p1- 62 (17/10/2022 tarihinde https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1468)
R T D Oliver, M D Mason, G M Mead et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet, 2005;366: 293.
R Timothy D Oliver, Graham M Mead, Gordon J S Rustin et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol, 2011;29: 957.
Graham M Mead, Sophie D Fossa, R Timothy D Oliver et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. J Natl Cancer Inst, 2011;103: 241.
Stefanie Fischer, Torgrim Tandstad, Matthew Wheater et al. Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma. J Clin Oncol, 2017;35: 194. DOI: 10.1200/JCO.2016.69.0958
Albers P, Albrecht W, Algaba F et al. EAU Guidelines on Testicular Cancer, 2015;1- 60.
Hiten D Patel, Arnav Srivastava, Ridwan Alam et al. Radiotherapy for stage I and II testicular seminomas: Secondary malignancies and survival. Urol Oncol, 2017;35: 606. DOI: 10.1016/j.urolonc.2017.06.051
Christian Kollmannsberger, Torgrim Tandstad, Philippe L Bedard et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol, 2015;33: 51.
R J Groll, P Warde, M A S Jewett A. Comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol, 2007;64:182.
R S Foster, B J Roth. Clinical stage I nonseminoma: surgery versus surveillance. Semin Oncol, 1998; 25:145.-
Shane M Pearce, Shay Golan, Michael A Gorin et al. Safety and Early Oncologic Effectiveness of Primary Robotic Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Testicular Cancer. Eur Urol, 2017;71: 476. DOI: 10.1016/j.eururo.2016.05.017
Peter Albers, Roswitha Siener, Susanne Krege et al. Randomized phase III trial comparing retroperitoneal lymph node dissection with one course of bleomycin and etoposide plus cisplatin chemotherapy in the adjuvant treatment of clinical stage I Nonseminomatous testicular germ cell tumors: AUO trial AH 01/94 by the German Testicular Cancer Study Group. J Clin Oncol, 2008;26: 2966.
