Annals of Oncology 13:237-242, 2002
© 2002 European Society for Medical Oncology
Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk?
Cancer Research Campaign, Wessex Medical Oncology Unit and Department of Radiology, Royal South Hants Hospital, Southampton,UK
Received 26 March 2001; revised 22 August 2001. accepted 27 August 2001.
Background
The standard management approach to stage I testicular non-seminomatous germ-cell tumours (NSGCT) in the UK is a surveillance programme with adjuvant bleomycin, etoposide, cisplatin (BEP) chemotherapy being offered to individuals with high risk disease. Conventionally, computed tomography (CT) scanning of the thorax has formed part of the surveillance programme. This paper evaluates the contribution of routine thoracic CT imaging in the management of this disease.
Patients and methods
We retrospectively reviewed the case notes of 168 patients with stage I NSGCT referred to the Wessex Medical Oncology Unit over a period of 13 years (1986–1998). These patients entered onto a surveillance programme that included serial chest X-ray follow up rather than thoracic CT.
Results
Forty-two out of 168 patients (25%) evaluated suffered relapse during the follow up period. Eight of 42 patients (19%) relapsed with intrathoracic disease. Seven out of eight of these patients (87.5%) had at least one other indicator of disease recurrence (elevated serum marker, abnormal abdominal CT). One of 42 patients (2.4%) relapsed with isolated intrathoracic disease with no other indicator of relapse. All patients with intrathoracic relapse had evidence of disease on chest X-ray. Of the 42 relapsing patients, 93% could be categorised as having good prognosis metastatic disease. Seven per cent relapsed with intermediate or poor prognostic disease; relapse in these patients would not have been detected earlier with the inclusion of routine thoracic CT. Only one patient has died giving a cure rate of 98% for relapsing patients.
Conclusions
The elimination of chest CT did not compromise outcome but significantly reduced radiation exposure thereby minimising the risk of radiation-induced secondary malignancy. Continued review of surveillance programmes is essential if we are to optimise management of this disease.
Key words: stage I non-seminomatous germ-cell cancer, surveillance programme, thoracic computed tomography scans
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