How to improve adherence of guidelines for localized testicular cancer surveillance: A Delphi consensus study.

Stage-I testicular germ-cell tumor (TGCT) has excellent cure rates. Surveillance is fully included in patient's management, particularly during the first years of follow-up. Surveillance guidelines differ between the academic societies, mainly concerning imaging frequency and long-term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. First, an online survey on surveillance practice of stage-I TGCT based on clinical-cases was conducted among urologists, radiation-oncologists and medical-oncologists. These results were compared to ESMO/EAU and AFU guidelines. Then a panel of experts assessed surveillance proposals following a Delphi-CM. Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. The study was conducted between July 2018 and May 2019. Concerning the first step: 61 participated to the survey (69% medical-oncologists, 15% urologists, 16% radiation-oncologists). About 65% of practitioners followed clinico-biological guidelines concerning 1 to 5 years of follow-up, but only 25% stopped surveillance after the 5th-year. No physician followed the EAU/ESMO guidelines of de-escalation chest imaging. Concerning the second step: 32 experts (78% medical-oncologists, 16% urologists, 6% radiation-oncologists) participated to the Delphi-CM. Thanks to Delphi-CM, a consensus was reached for 26 of the 38 statements. Experts agreed on clinico-biological surveillance modalities and end of surveillance after the 5th-year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th-year of follow-up. No consensus was reached regarding de-escalation of chest imaging. To conclude, the survey proved that French TGCT-specialists do not follow current guidelines. With Delphi-CM, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th-year, stop of AP scan on the 4th-year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.

Frontiers in oncology. 2022 Oct 17*** epublish ***

Angélique Da Silva, Aude Fléchon, Elodie Coquan, François Planchamp, Stéphane Culine, Thibaut Murez, Arnaud Méjean, David Pasquier, Christine Chevreau, Karim Fizazi, Antoine Thiery-Vuilemin, Florence Joly

Centre François-Baclesse, Department of Medical Oncology, Caen, France., Centre Léon Bérard, Department of Medical Oncology, Lyon, France., Institut Bergonié, Clinical Research Unit, Bordeaux, France., Hôpital Saint-Louis, Department of Medical Oncology, Paris, France., Hôpital Lapeyronie, Department of Urology, Montpellier, France., Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Department of Urology, Paris, France., Centre Oscar Lambret, Department of Radiation Oncology, Lille, France., Oncopôle, Department of Medical Oncology, Toulouse, France., Gustave Roussy, University of Paris Sud, Department of Medical Oncology, Villejuif, France., CHRU Besancon, Hôpital Jean Minjoz, Department of Medical Oncology, Besancon, France.