The majority of germ cell tumour (GCT) patients can be cured by orchiectomy followed by active surveillance or subsequent systemic and/or local treatments. There are various guidelines for a structured follow-up including radiographic and clinical examinations.
The Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS) prospectively evaluates follow-up, indicator of relapse and late toxicities. This is a descriptive analysis; we present baseline characteristics and treatment strategies for the first 299 patients with primary GCT or relapsed GCT after completion of treatment.
Of the patients included in this study, 192 (64.2%) had seminoma and 107 (35.8%) non-seminoma tumour. Mean age was 41 years (standard deviation [SD] 11.7) for seminoma and 31 (SD 9.3) years for non-seminoma patients. Median tumour size was 3.5 cm (interquartile range 0-12) in both histological groups. Among seminoma patients, 81 (42.2%) had primary tumours >4cm; 154 (80.2%) seminoma patients had stage I, 26 (13.5%) stage II and 12 (6.3%) stage III disease. Fifty-seven (53.3%) non-seminoma tumours were stage I, 29 (27.1%) stage II and 21(19.6%) stage III. Marker-positive disease was present in 58 (30.2%) seminoma patients and 78 (72.9%) non-seminoma patients. Of 154 stage I seminoma patients, 89 (57.8%) chose active surveillance and 65 (42.2%) adjuvant chemotherapy. Twenty-six (45.6%) stage I non-seminoma patients had high-risk disease; 23 of these were treated with adjuvant chemotherapy and 3 chose active surveillance. Among the 30 (52.6%) low risk stage I patients, all opted for active surveillance. Twelve (46.2%) stage II seminoma patients had radiotherapy, 14 (53.8%) were treated with three to four cycles of chemotherapy. All stage III seminoma patients, and all stage II and III non-seminoma patients were treated with three to four cycles of chemotherapy. Treatment decisions were made at the respective centre. Five patients did not receive therapy that conformed with guidelines.
It is important to enrol GCT patients in prospective studies in general, but also in follow-up studies to assess baseline characteristics, oncological outcome, and long-term toxicity and to validate the performance of follow-up schedules. This is the first time that the distribution of disease, detailed baseline characteristics and the respective treatment of men with GCT is collected in a prospective manner in German speaking countries (Switzerland, Austria and Germany) and therefore patterns of care have been evaluated. SAG TCCS results will inform on future modifications of surveillance schedules and follow-up procedures.
Swiss medical weekly. 2018 Jul 24*** epublish ***
Christian Rothermundt, Claudio Thurneysen, Richard Cathomas, Beat Müller, Walter Mingrone, Anita Hirschi-Blickenstorfer, Tobias Wehrhahn, Christian Ruf, Sacha Rothschild, Bettina Seifert, Angelika Terbuch, Thomas Grassmugg, Regina Woelky, Christian Fankhauser, Thomas Kunit, Natalie Fischer Fischer, Roman Inauen, Jörn Kamradt, Katrin Ziegler, Alan Haynes, Peter Jüni, Silke Gillessen
Klinik für Medizinische Onkologie und Hämatologie, Departement Innere Medizin, Kantonsspital St. Gallen, Switzerland., Kantonsspital Graubünden, Abteilung Onkologie und Hämatologie, Chur, Switzerland., Luzerner Kantonsspital, Medizinische Onkologie, Luzern, Switzerland., Onkologiezentrum, Kantonsspital Olten, Switzerland., Onkozentrum Hirslanden, Klinik Hirslanden, Zürich, Switzerland., Zentrum für Onkologie/Hämatologie, Kantonsspital Aarau AG, Switzerland., Urologische Abteilung, Bundeswehrzentralkrankenhaus Koblenz, Germany., Departement Innere Medizin, Medizinische Onkologie, Universitätsspital Basel, Switzerland., Onkologie, Kantonsspital Baselland, Liestal, Switzerland., Abteilung für Onkologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Austria., Medizinische Onkologie, Kantonsspital Frauenfeld, Switzerland., Department of Urology, University Hospital Zurich, University of Zurich, Switzerland., Universitätsklinik Salzburg für Urologie und Andrologie, Landeskrankenhaus, Salzburg, Austria., Medizinische Onkologie, Kantonsspital Winterthur, Swizterland., Medizinische Onkologie, Kantonsspital Münsterlingen, Switzerland., CTU Bern, and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland., Applied Health Research Centre St. Michaels, Toronto, Ontario, Canada., University of Bern, Switzerland.