Buenos Aires, Argentina (UroToday.com) Jens Bedke, Professor University of Tubingen, discussed surgery in management of clinical stage T1 NSGCT.
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Imaging may understage patients up to 30% of patients with current imaging modalities ie CT imaging. Chemotherapy raises toxicity concerns and delayed recurrence with radiation toxicity. Excellent rates for cure with clinical stage 1 seminomatous and NSGCT with potential risk for toxicities due to increased survival and young age of patients makes surgery a feasible treatment option. RPLND may be performed in a template, nerve-sparing fashion which further limits morbidity concerns. Current guidelines recommend 1 postoperative CT following surgery compared to repeat imaging needed following chemotherapy for up to 5 years. Moreover, minimal morbidity with surgery including advances in robotics make surgery an attractive option (but increasingly underutilized) in the management of these patients. The retroperitoneum is the primary landing zone for NSGCT and patients with ominous findings at orchiectomy (LVI and embryonal predominant tumor at orchiectomy) are at increased risk for disease in the retroperitoneum and may benefit from additional therapy. When performed in expert hands, RPLND has excellent oncologic outcomes with minimal morbidity and should be considered in the management of stage I NSGCT.
World Urological Oncology Federation Symposium at the SIU Congress 2016 - October 20 - 23, 2016 – Buenos Aires, Argentina
Written By: Stephen B. Williams, M.D., Assistant Professor in Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish Kamat, M.D. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.