Follow up (again)

[chrisg551390]

I've asked about this before. At my last appointment I was told I would not have any more CT scans only chest x ray and markers for the next four years. Is any one else on this sort of follow up?

[Smartie]

Is any one else on this sort of follow up?

I am not on this type of follow up. However, I'd suggest checking out the NHS's guidelines on this, which say:

The European Society for Medical Oncology recommends follow-up of seminoma after adjuvant chemotherapy or radiotherapy should include [12]:

physical examination and tumour marker analysis:
4 times per year during the first year
3 times during the second year
twice per year during the third to fifth years
chest X-ray:
twice per year during the first to third years
once per year during the fourth up until the fifth year
abdominopelvic CT scan:
twice per year during the first and second years
once per year during the third and fifth year (emphasis added).

The full map of medicine is available here.

[Aegean]

Are you sure you are not in a study. I believe the Marsden is conducting one for seminoma with greatly reduced CT scans, no CT scans and MRI instead of CT... see this trial called TRIAL OF IMAGING AND SCHEDULE IN SEMINOMA
TESTIS

[chrisg551390]

No definitely not in a trial.
I was so pleased my CT was clear I didn't think about what was said until I was back at home.
I'm going back in six months so i can query it then.

[TCdoc]

Are you sure that they're not confusing non-seminoma with seminoma. My follow up after 4xEP for mixed germ cell is CxR and markers. I queried why no CT scan during follow-up and was told that it was because my lymph nodes had completely resolved and it was highly unlikely to recur. My understanding is that seminoma follow-up requires CT scanning.

[Smartie]

My understanding is that seminoma follow-up requires CT scanning.

Indeed. As the guidelines state.

[apple]

Hi,

My schedule for follow-up scans after stage 1 seminoma treated with single dose carboplatin comprises 3 CT scans: two in the first year, and one at the end of year 2.

After that, just markers and the odd x-ray.

If I remember correctly, from the big trial of carboplatin vs radiotherapy (Oliver et al), I think that the median time to relapse was 9 months, and no-one relapsed after 2 years.

My oncologist certainly thinks that the chance of relapse after 2 years is absolutely minimal. I suppose this protocol reflects the current emphasis of reducing morbidity (i.e. exposure to radiation in CT scans) in this very curable condition.

Great news that your scan was clear, by the way!

Cheers,
Adrian

[apple]

This article reviews outcomes in stage 1 seminoma from 3 large trials:

http://jnci.oxfordjournals.org/conte...3/241.abstract

The authors state that relapse occurred after 3 years in only four (0.2%) of all 2466 patients.

I only have the abstract at the moment, but I'll try to get the full text when I'm back at work.

A

[apple]

This is the study with the relapse data I quoted. It wasn't the Oliver study, it was the Spanish one:

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

A

[chrisg551390]

So I think the message from all of this is why do harm looking for something which is almost certainly not going to happen.
Hence the minimal harm approach of chest x rays only.
Wasn't looking forward to any more CT as all the contrast ended up on the floor and not in me!