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Lymph node growth rate in testicular germ cell tumours...Abstract

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  • Lymph node growth rate in testicular germ cell tumours...Abstract

    A frequently asked question.

    Lymph node growth rate in testicular germ cell tumours: Implications for computed tomography surveillance frequency - Abstract
    Testicular Cancer
    Saturday, 29 January 2011 |
    Joint Department of Medical Imaging, University of Toronto, Canada.

    To estimate the growth rate of lymph nodes in patients on surveillance for testicular cancer who developed recurrent disease.

    During a 7-year period, 318 patients at our institution were managed by surveillance and 39 relapsed (12.3%). The computed tomography scans of 28 patients (median age 32 years; range 19-51 years) who met our inclusion criteria and who developed recurrent disease in the abdomen/pelvis were retrospectively reviewed. Thirteen patients had non-seminoma and 15 had seminoma. To estimate the lymph node growth rate, the slope of lymph node size over time was calculated.

    The median length of time from orchiectomy to the recurrence computed tomography was 131 days (range 49-520) or about 4.4 months for non-seminoma patients and 373 days (range 129-675) or about 12.3 months for seminoma patients. The median size of the involved lymph node at final computed tomography for seminoma patients was 12mm (range 9-31mm) and for non-seminoma patients was 15mm (range 10-56mm). The median lymph node growth rate for patients with seminoma was 1.35mm/month (range 0.62-4.56) and for patients with non-seminoma 2.99mm/month (range 0.77-7.06); the difference in growth rates was statistically significant (P=0.029).

    There is a statistically significant faster growth rate of lymph nodes in patients with recurrent non-seminoma compared with patients with seminoma. This finding supports a more frequent computed tomography schedule during the first 2 years of surveillance in non-seminoma patients compared with seminoma patients.

    Written by:
    Mazrani W, O'Malley ME, Chung PW, Warde P, Vesprini D, Panzarella T.
    Reference: Clin Oncol (R Coll Radiol). 2010 Nov 15. [Epub ahead of print]
    doi: 10.1016/j.clon.2010.10.006

    PubMed Abstract
    PMID: 21084179

    UroToday.com Testicular Cancer Section
    "Statistics are human beings with the tears wiped off" - Paul Brodeur
    Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

  • #2
    Does this slower growth rate for seminoma also apply to tumors outside of the lymph nodes - in other words, do tumors in the mediastinum, testicle and other locations also grow about half as slowly as non-seminoma tumors? I wonder if this can be extrapolated?
    Heidi

    Husband - age 51
    10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
    11/1/10 4X BEP
    12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
    2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
    6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
    Surveillance since 6/11

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    • #3
      "The median lymph node growth rate for patients with seminoma was 1.35mm/month (range 0.62-4.56) and for patients with non-seminoma 2.99mm/month (range 0.77-7.06)"...

      Does the rate of growth depend at all on whether it is teratoma or something else in the lymph node? If this is the rate for teratoma, then is it also growing at this rate during chemo --- at almost 3 mm a month, then during the 9-12 weeks of BEPx3 (for instance), would it be expected to grow 12 mm? thanks, embee
      Nephew Will (19 years old)

      2-14-11 Left I/O; 50% EC, 40% teratoma; 10% yolk sac
      3-14-11: BEPx3
      4-18-11: Markers normalize
      6-13-11: IU pathology: 60% teratoma, 35% EC, 5% yolk sac
      7-7-11: left modified template nerve sparing RPLND at IU; 2/19 nodes with teratoma (2%), rest necrotic
      10-01-11: 1st post-RPLND TM ALL CLEAR
      12-01-11: 1st post-RPLND CT ALL CLEAR

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