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  • NCCN Guidelines for Testicular Cancer

    The NCCN Clinical Practice Guidelines for the treatment of Testicular Cancer have been updated, and there are several major changes noted:
    • All three management strategies for stage I-A and I-B seminoma (surveillance, adjuvant radiation and adjuvant chemotherapy) are rated "category 1", meaning that there is a uniform consensus among experts on their recommendation as approved treatment.
    • Post-chemotherapy surgical resection of residual masses (> 3 cm) for seminoma patients is now considered an option, though not by uniform consensus.
    • Poor risk, stage III-C non-seminoma patients have the option of going straight into 4xVIP (etoposide, ifosfamide, cisplatin) as primary chemotherapeutic treatment instead of 4xBEP in cases where tolerance for bleomycin might be a problem.

    Note: The "discussion" write-up at the end of the guidelines has not been updated yet. The manuscript is currently in the works.
    "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
    11.22.06 -Dx the day before Thanksgiving
    12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.


  • #2
    NCCN Update

    It is good to finally see a stronger recommendation for carboplatin therapy for stage I seminoma. Dr. Oliver just presented his data on carboplatin at ASCO too.
    http://www.renalandurologynews.com/S...rticle/116119/
    Oct. 2005 felt lump but waited over 7 months.
    06.15.06 "You have Cancer"
    06.26.06 Left I/O
    06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
    06.30.06 It's Official - Stage I Seminoma
    Surveillance...
    Founded the Testicular Cancer Society
    6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

    For some reason I do not get notices of private messages on here so please feel free to email me directly at mike@tc-cancer.com if you would like to chat privately so as to avoid any delays.

    Comment


    • #3
      It is good to see single-agent carboplatin moving up the ladder of confidence and efficacy. I note, however, that the Follow-up protocol (scans, etc.) for carboplatin is still the same frequency as for Surveillance instead of the more relaxed frequency for XRT. Perhaps that will be changed as this draft moves along to final version. Otherwise, the assumption is that the board does not entirely agree that carbo reduces recurrence probability to the same low level as XRT.

      Per the article Mike linked, and which I've seen elsewhere, if the findings that carbo significantly reduces the probability of developing a secondary (TC-2) is validated by another study, that alone would be a very compelling reason to jump on the bandwagon.
      "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)

      Comment


      • #4
        It's good to see this updated set of guidelines, although I'd be interested in seeing more said about bilateral cases (notably where the most extensive XRT field was used for TC1) as the justification that I've been given for my aggressive surveillance (certainly more aggressive than for classic stage IA seminoma) is precisely the fact that I'm bilateral and had prior full-field XRT. I suppose the guidelines are just that - guidelines - but it would be interesting to see a discussion in them of cases that don't quite fit the established categories.
        TC1: 1996, right orchiectomy, seminoma stage I 3.5 cm mass, radiation therapy (peri-aortic & pelvic 27.3 Gy)
        TC2: 2008, left orchiectomy, seminoma stage IA 5 cm mass, left & right prostheses, AndroGel TRT, surveillance at MSKCC

        Comment


        • #5
          Originally posted by Paul54 View Post
          Per the article Mike linked, and which I've seen elsewhere, if the findings that carbo significantly reduces the probability of developing a secondary (TC-2) is validated by another study, that alone would be a very compelling reason to jump on the bandwagon.
          I have read that article, and, as it stands, I don't buy it. I believe the evidence is circumstancial, and like you said, further studies are warranted if they really want solid proof that carbo prevents a contralateral presentation.
          "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
          11.22.06 -Dx the day before Thanksgiving
          12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

          Comment


          • #6
            v.2.2009 available

            The write-up at the end of the NCCN guidelines has been updated to reflect the most recent recommendations for treatment.
            "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
            11.22.06 -Dx the day before Thanksgiving
            12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

            Comment


            • #7
              I see that the new NCCN.com site for patients is available, though a patient version of the testicular cancer guidelines is not yet. The guidelines for physicians are still available to all, though registration with the NCCN.org website is now required first.
              Scott, scott@tc-cancer.com
              right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


              Your donation funds LIVESTRONG Foundation services for people facing cancer now. Please join me!

              Comment


              • #8
                NCCN Guidelines Updated

                The NCCN Clinical Practice Guidelines for the treatment of testicular cancer have been updated to v.1.2010. Among the most notable changes are the following:
                • The term "salvage therapy" has been renamed "second-line therapy".
                • High-dose chemotherapy has been added as a validated treatment option.
                • Follow-up abdominal/pelvic CT scans for surveillance 6+ years post-treatment should only be done as "clinically indicated". Also, there is clarification noting that patients who have undergone an RPLND need not be followed by CT scan as long as they have a baseline read after surgery. Patients who have gone through chemotherapy alone should still have CT scans as indicated in the schedule.
                "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
                11.22.06 -Dx the day before Thanksgiving
                12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

                Comment


                • #9
                  Originally posted by Fed View Post
                  The term "salvage therapy" has been renamed "second-line therapy"
                  Good, I've always preferred that term!
                  Scott, scott@tc-cancer.com
                  right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


                  Your donation funds LIVESTRONG Foundation services for people facing cancer now. Please join me!

                  Comment


                  • #10
                    I just caught the post regarding cat scans and no longer needing every year if chemo and RPLND were done.....Chris just had his fifth cat scan....so now we should be set, correct? Even if teratoma was present, I presume...this is wonderful news knowing cat scan exposure would not be needed unless there were some problem...I would appreciate any feedback regarding my assumptions here....what good news to tell Chris..thanks for the information Mary Ellen

                    Comment


                    • #11
                      Jason is 6 years from diagnosis on April 30th. He has his last cat scan this week. From now on it will be blood work and x-rays to keep a watch on those stupid lung spots.
                      Son Jason diagnosed 4/30/04, stage III. Right I/O 4/30/04. Graduated College 5/13/04. 4XEP 6/7/04 - 8/13/04. Full open RPLND 10/13/04. All Clear since.

                      Treated by Dr. Rakowski of Midland Park, NJ. Visited Sloan Kettering for protocol advice. RPLND done at Sloan Kettering.

                      Comment


                      • #12
                        Question for Fed

                        Hello Fed, I just read your summary on CT scans for RPLND patients. That would not apply in Joe's case would it? Given that his tertoma tranformed to adenocarcinoma and it is only identifiable by CTs and not bloodwork? He goes tomorrow for his 1 year and is hoping to get moved to every 4 months from 2 months. Hope all is well. Dawn
                        sigpicJoe
                        --------------------------------------------------------------------
                        Son Joe diagnosed 11/10/08 Nonseminoma Stage llB
                        2 enlarged abdominal lymph nodes
                        Right I/O 11/14/08
                        Chemo 3xBEP completed 1/28/08
                        lymph node growth during chemo
                        RPLND 3/12/09 - tumor and vena cava path now
                        adenocarcinoma

                        Comment


                        • #13
                          Unable to see the document... wish I could, because I need some hard evidence to present to Nick's doc in case she wants to delay cycle 3 (already 2 was delayed by a week). I have been unable to find a thing and I can't very well say, "oh, I saw it on a forum," to a doctor---they don't usually take kindly to that.
                          ~Carole


                          Son Nick, age 25
                          2/26/2010 Left I/O
                          100% Seminoma, Stage IIC
                          6cm Tumor in abdomen w/ lymph involvement
                          Started 3X BEP 3/29/2010
                          *ALL CLEAR 9/15/10!!! *
                          Lung clot dissolved!

                          Comment


                          • #14
                            Originally posted by NixMom View Post
                            Unable to see the document...
                            The guidelines are available at no charge after you register with the website: http://www.nccn.org/
                            Scott, scott@tc-cancer.com
                            right inguinal orchiectomy 6/5/2003 > nonseminoma, stage I > surveillance > L-RPLND 6/24/2005 for recurrence, suspected teratoma but found seminoma, stage II > chylous ascites until 9/2005 > surveillance and "all clear" since


                            Your donation funds LIVESTRONG Foundation services for people facing cancer now. Please join me!

                            Comment


                            • #15
                              Thanks, snagged it.
                              ~Carole


                              Son Nick, age 25
                              2/26/2010 Left I/O
                              100% Seminoma, Stage IIC
                              6cm Tumor in abdomen w/ lymph involvement
                              Started 3X BEP 3/29/2010
                              *ALL CLEAR 9/15/10!!! *
                              Lung clot dissolved!

                              Comment

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