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RPLND at Johns Hopkins

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  • biwi
    replied
    RPLND can be curative for stage 2 non-seminoma if the nodes are small enough and it is not advanced enough. But time would be of the essence. I would not have an issue having an RPLND to potentially avoid chemotherapy altogether. RPLND generally has less long term health effects than 3xBEP/4xEP.

    EDIT: RPLND here in this situation seems to actually be preferred to chemo if you read the 2018 NCCN guidelines for testicular cancer. Note Stage 2a, markers NOT elevated.
    Last edited by biwi; 04-18-19, 02:59 PM.

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  • vxmike
    replied
    Originally posted by Davepet View Post
    The percent of teratoma has not been specified, so impossible to know how significant that might be. however teratoma is NOT a cancer. Even though it can cause problems or even transform to a TC down the road. Difficult to know what to do in a case like this. If it were me, unless the teratoma component was very large & everything else very low, I think I'd want chemo to kill anything anywhere & RPLND if anything remained. JMHO.
    Personally I’d push for a biopsy to see if there’s any teratoma present. While it’s not a cancer it can still be very bad if it surrounds or adheres to the aorta or vena cava. That turns a future RPLND into a major vascular surgery as well. Very tough call.

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  • jerrie85
    replied
    I have a very similar case history to you Balance - I too had YK, T and EC (minus seminoma), my AFP dropped to 4, before it started ticking back up to 13, and had 3 enlarged nodes on CT. Granted I had elevated HCG as well that helped with a more definitive diagnosis, but I think in your case, it’s best to wait and see if there’s a positive trend to your AFP. Within a couple of weeks, you should have your answer I think.

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  • Davepet
    replied
    The percent of teratoma has not been specified, so impossible to know how significant that might be. however teratoma is NOT a cancer. Even though it can cause problems or even transform to a TC down the road. Difficult to know what to do in a case like this. If it were me, unless the teratoma component was very large & everything else very low, I think I'd want chemo to kill anything anywhere & RPLND if anything remained. JMHO.

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  • vxmike
    replied
    indeed be necessary later, you’ll end having to go into chemo with a body that is still recovering from the effects of the surgery. You need a systemic treatment, and that will likely be 3x BEP.[/QUOTE]

    But his markers are normal. I generally agree with the chemo sentiment, but there is teratoma in the testicular specimen. If any of the enlarged nodes have teratoma then chemo will be ineffective and he’d end up with both. This is a really tough call given the teratoma component.

    Wonder if a biopsy of the nodes would help clarify?

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  • Davepet
    replied
    AFP below 20 is not cause for concern, but nodes greater than 1CM are. I would personally prefer chemo with enlarged nodes & non seminoma, since some non seminoma can spread via blood & is not detectable in the lymph system. RPLND is somewhat less effective than chemo in those cases. Tough call, I'm afraid.

    Dave

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  • Balance
    replied
    Well my markers arent elevated. They are increasing but still in the normal range. So I think thats why both Einhorn and Cary agree to have an RPLND.

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  • jerrie85
    replied
    Far be it for me to go against Einhorn here, but I would not recommend you do an RPLND. That is usually only reserved when there is no elevated markers. In your case, the RPLND is unlikely to be curative, and would not only be a potential waste of time, but if chemo will indeed be necessary later, you’ll end having to go into chemo with a body that is still recovering from the effects of the surgery. You need a systemic treatment, and that will likely be 3x BEP.

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