- Email: [email protected]
C129 POPULATION-BASED STUDY OF PERIOPERATIVE MORTALITY AFTER RETROPERITONEAL LYMPHADENECTOMY FOR NONSEMINOMATOUS TESTICULAR TUMORS
C126
Adjuvant radiotherapy ST I-II seminoma: Prognostic factors, toxicity and long-term results
Cabeza Rodriguez M.A., Cascales García M.A., Martinez Gutierrez R., D’ambrosi Mata R., Bartolome A., Ruiz Alonso A., Perez Regadera J.F, Lanzos E. Hospital Universitario 12 De Octubre, Dept. of Radiation Oncology, Madrid, Spain Introduction & Objectives: Standard treatment of ST I-II seminoma is radical orchiectomy followed by adjuvant radiotherapy (RT). Objective: Retrospective analysis of long-term results in terms of overall survival (OS), disease-free survival (DFS), acute and chronic toxicity and incidence of second malignancies in a cohort of patients with seminoma treated with RT after orchiectomy. Material & Methods: Retrospective analysis of 76 patients with ST I-II seminoma treated with RT after orchiectomy between 1980 and 2008. Mean age was 36 + / -12 years. 13% had a history of cryptorchidism. 96% were diagnosed by local symptoms. There was an elevated B-HCG and / or LDH before surgery in 5% of patients. Inguinal orchiectomy was used in 90% of patients. Spermatocytic variant was found in 3 patients, having the rest classic seminoma. Median tumor diameter 4.8 cm (r: 1-14). 78% were ST I, 22% ST II. In 74% of patients the PTV included para-aortic nodes and ipsilateral iliac. Median Total Dose was 25.2 Gy (range 4020). Fractionation ranged from 1.8 to 2 Gy / day. Patients have continued regular clinical controls. Results: Median follow-up was 109 months (range 4-334 months). There was a systemic failure at 37 months after treatment ends. The DFS at 10 and 20 years was 98%; with a 10-year OS of 100% and 20 years OS of 90%. Acute toxicity according to CTCAE-v4 scale was: 17% Gastrointestinal G II, G III 1%. Blood G II 1%. No chronic toxicity was observed. Three patients have developed second malignancies outside the treatment field at 9, 12 and 25 years respectively. Conclusions: Adjuvant RT after inguinal orchiectomy is an effective and safe in testicular seminoma ST I-II with excellent long-term results in terms of DFS and OS as well as the absence of chronic toxicity, providing an excellent quality of life in these patients.
C127
Predicting teratoma (T) in the retroperitoneum (RP) in men undergoing post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLA)
Argirović D.1, Argirović A.2 1 . Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2Clinical Hospital Center Zemun-Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: The biological potential of T remains unpredictable. Therefore indentifying its presence in RP remains important point. We evaluated patients (pts) undergoing PC-RPLA for metastatic non-seminomatous testicular tumors (NSTT) to determine predictors of T elements in the RP. Material & Methods: We indentified 161 pts who underwent PC-RPLA for metastatic NSTT between 1982 and 2005. Multiple clinical and pathological variables were reviewed from our prospective PC-RPLA database. A logistic regression model was designed based on preoperative variables to predict presence of T elements in the PC-RPLA specimen. Pts undergoing ERP surgery were not included in this study because our previous analysis demonstrated that these pts might be at higher risk of recurrence and worse survival, independently of tumor histology on surgery. Results: Of the 161 pts in our series 112 (70%) received only induction C and 49 930%) required 2nd line C. Study of RP pathology demonstrated the presence of fibrosis in 44 (27%) pts, T in 82 (51%) pts, and viable GCT in 35 (22%) pts. Among 82 pts with finding of T elements at PC-RPLA we revealed the presence of mature T in 85%, immature T in 12% and T with malignant transformation in 3%. Of the 99 pts with T elements in the primary NSTT, 64 (65%) had T at PC-RPLA. Even in the absence of T in the primary NSTT, T was present in the RP in 18 of 62 pts (29%)(p<0.0001). Good vs. intermediate/poor IGCCCG risk criteria occurred in relation of 6% vs. 11%. All pts had normal values of STMs at PC-RPLA. PC RM from 2.1-5 cm and > 5 cm occurred in 52% and 55% pts, respectively. 15 pts (26%) received 2nd line C. Pts with no change or increasing nodal size and those with smaller reduction in nodal size following C were more likely to have T in the resected specimen. The 5- year (y) disease-specific survival (DSS) and relapsefree survival (RFS) rates were 97.6% and 87.5%. The 10-y DSS and RFS rates were 88.54% and 81.2% (log Rank=15.315; p<0.0001). By multivariate analysis T in the orchiectomy specimen (p<0.005), relative change in nodal size before and after C (p<0.005), and no requirement for 2nd line C (p=0.03) were independent predictors for the presence of the T in the RP. While IGCCCG risk classification was not significant predictor of T in the RP, there was a trend (p= 0.093) with intermediate/poor risk pts having a higher probability of RP T at PC-RPLA. Conclusions: T remains a common histological finding in RP LN following C. We have indentified pre-RPLA variables that predict the finding of T in the RP for men treated with C for metastatic NSTT.
Eur Urol Suppl 2011;10(9):644
C128
Long-term follow-up of cisplatin combination chemotherapy (C) in patients (pts) with disseminated nonseminomatous testicular tumors (NSTT): is a post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLA) needed after complete remission (CR)?
Argirović D.1, Argirović A.2 1 Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2Clinical Hospital Center Zemun-Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Controversies arises regarding the optimal management of pts with NSTT who achieve a serologic and radiographic CR to systemic C. Some authors recommend PC-RPLA, whereas others omit surgery and observe these pts. In an attempt to address this question, we report long-term follow-up (FU) of pts who achieved a CR to 1st line C and were observed without PC-RPLA. Material & Methods: This is a retrospective analysis of 216 pts with metastatic NSTT who achieved a CR to 1st line C and were monitored without further therapy. CR was defined as normalization of STMs and complete resolution of all radiographic disease (ds). Results: Mean age was 27 year (y), teratoma (T) compound was present in the primary tumor in 82 (38%) pts, 54 (25%) pts were in CS III, and 79 (37%) pts had RP RM > 5 cm. 3 (1%) had < 2 y FU and 136 (63%) > 10 y. After a MFU of 160.3±62.2 months (m), 15 (7%) pts experienced relapse. Of these 15 pts, 9 pts currently have no evidence of ds (NED) and 6 pts died of ds. 8(4%) pts died while ds-free and 4(2%) died of unknown causes. The 5- , 10- y DSS and RFS rates were 90%, 88% and 84%,69%, respectively (Log Rank=37.25; p<0.0001). The 5- and 10-y overall survival rates were 90% and 84%, respectively. The 5-, 10-y DSS rates for good risk pts (n=159) vs intermediate/poor risk pts (n=57) were 99%, 95% and 99%, 93%, respectively (Log Rank=14.816; p<0.0001). Probability of remaining relapse free after achieving CR according to good vs intermediate/ poor IGCCCG risk group were 99% and 75%, respectively (Log Rank=16.015; p=0.001). 9 (6%) pts experienced recurrence in the RP within MFI of 29 m (range, 6 – 120 m), of whom 3 pts died of ds. 5 pts had late relapse (range, 25 – 120 m), including 3 pts in the RP. 3 pts currently have NED. On univariate analysis RP RM size and T in the orchiectomy specimen were not predictive for DSS, whereas the sole predictor was IGCCCG risk classification (p=0.001). 3(1%) pts had 2nd GCTT developed between 5 m to 17 y after initial diagnosis (all pts had CS I, with discordant histology, 2 underwent surveillance). Conclusions: Pts obtaining a CR after 1st line C can be safely observed without PC-RPLA. Relapses are rare and potentially curable with further treatment.
C129
Population-based study of perioperative mortality after retroperitoneal lymphadenectomy for nonseminomatous testicular tumors
Argirović D.1, Argirović A.2 1 Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2Clinical Hospital Center Zemun-Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: The present study is performed to determine wheter retroperitoneal lymphadenectomy (RPLA) perioperative mortality (PM) rates reported from a center of excellence [Indiana University: 0% for primary and 0.8% for postchemotherapy (PC) RPLA] are applicable to institution of large. Material & Methods: We used the data from 327 assessable pts with nonseminomatous testicular tumors (NSTT) treated with RPLA from 1975 to 2005 asseses from clinical data- base: primary in 134 pts (41%) and PC-RPLA in 193 pts (59%). The observed PM rates were stratified according to age, clinical stage (CS) and type of RPLA. Results: The median age at RPLA was 28 years (y)(range, 16-54):≤ 29 y in 184 (56.3%), 30-39 y in 99 (30.3%) and ≥ 40 y in 44 (13.4%) pts. Of 327 RPLA pts, 81 (27.8%) were performed for localized (CS-I), 179 (54.7%) for egional (CS-II) and 57 (17.5%) for metastatic (CS-III) disease (ds). 10 pts (3.1%) died during initial 90 days (d) after RPLA: 1 pt died of pulmonary embolism, 2 of C related toxicity and 7 of progressive ds due to perioperative worse prognostic factors. Of the entire cohort 30,60 and 90-d PM rate was 0.3%, 1.0% and 1.3%, respectively. PM rate increase with increasing age : ≥ 29y 0%, 30-39 y 5.0% and ≥ 40 y 11.4% (x2 trend test, p=0.002). PM also increased with increasing stage : 0% for localizd, 2.8% for regional and 8.8% for metastatic ds (x2 trend test, p<0.001). PM rate at primary vs PC-RPLA was 0.7% vs 3.1% (p<0.001). Conclusions: RPLA was associated with virtually no or low PM in pts with localized and regional ds. The PM rates from these 2 groups replicated those of Indiana University. In contrast, the PM rate of 8.8% for pts with distant metastases and group > 40 y of age (11.4%) implies that RPLA for these higher risk pts should be performed at centers of excellence, with intent of reducing the PM rate.
Adjuvant radiotherapy ST I-II seminoma: Prognostic factors, toxicity and long-term results
Cabeza Rodriguez M.A., Cascales García M.A., Martinez Gutierrez R., D’ambrosi Mata R., Bartolome A., Ruiz Alonso A., Perez Regadera J.F, Lanzos E. Hospital Universitario 12 De Octubre, Dept. of Radiation Oncology, Madrid, Spain Introduction & Objectives: Standard treatment of ST I-II seminoma is radical orchiectomy followed by adjuvant radiotherapy (RT). Objective: Retrospective analysis of long-term results in terms of overall survival (OS), disease-free survival (DFS), acute and chronic toxicity and incidence of second malignancies in a cohort of patients with seminoma treated with RT after orchiectomy. Material & Methods: Retrospective analysis of 76 patients with ST I-II seminoma treated with RT after orchiectomy between 1980 and 2008. Mean age was 36 + / -12 years. 13% had a history of cryptorchidism. 96% were diagnosed by local symptoms. There was an elevated B-HCG and / or LDH before surgery in 5% of patients. Inguinal orchiectomy was used in 90% of patients. Spermatocytic variant was found in 3 patients, having the rest classic seminoma. Median tumor diameter 4.8 cm (r: 1-14). 78% were ST I, 22% ST II. In 74% of patients the PTV included para-aortic nodes and ipsilateral iliac. Median Total Dose was 25.2 Gy (range 4020). Fractionation ranged from 1.8 to 2 Gy / day. Patients have continued regular clinical controls. Results: Median follow-up was 109 months (range 4-334 months). There was a systemic failure at 37 months after treatment ends. The DFS at 10 and 20 years was 98%; with a 10-year OS of 100% and 20 years OS of 90%. Acute toxicity according to CTCAE-v4 scale was: 17% Gastrointestinal G II, G III 1%. Blood G II 1%. No chronic toxicity was observed. Three patients have developed second malignancies outside the treatment field at 9, 12 and 25 years respectively. Conclusions: Adjuvant RT after inguinal orchiectomy is an effective and safe in testicular seminoma ST I-II with excellent long-term results in terms of DFS and OS as well as the absence of chronic toxicity, providing an excellent quality of life in these patients.
C127
Predicting teratoma (T) in the retroperitoneum (RP) in men undergoing post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLA)
Argirović D.1, Argirović A.2 1 . Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2Clinical Hospital Center Zemun-Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: The biological potential of T remains unpredictable. Therefore indentifying its presence in RP remains important point. We evaluated patients (pts) undergoing PC-RPLA for metastatic non-seminomatous testicular tumors (NSTT) to determine predictors of T elements in the RP. Material & Methods: We indentified 161 pts who underwent PC-RPLA for metastatic NSTT between 1982 and 2005. Multiple clinical and pathological variables were reviewed from our prospective PC-RPLA database. A logistic regression model was designed based on preoperative variables to predict presence of T elements in the PC-RPLA specimen. Pts undergoing ERP surgery were not included in this study because our previous analysis demonstrated that these pts might be at higher risk of recurrence and worse survival, independently of tumor histology on surgery. Results: Of the 161 pts in our series 112 (70%) received only induction C and 49 930%) required 2nd line C. Study of RP pathology demonstrated the presence of fibrosis in 44 (27%) pts, T in 82 (51%) pts, and viable GCT in 35 (22%) pts. Among 82 pts with finding of T elements at PC-RPLA we revealed the presence of mature T in 85%, immature T in 12% and T with malignant transformation in 3%. Of the 99 pts with T elements in the primary NSTT, 64 (65%) had T at PC-RPLA. Even in the absence of T in the primary NSTT, T was present in the RP in 18 of 62 pts (29%)(p<0.0001). Good vs. intermediate/poor IGCCCG risk criteria occurred in relation of 6% vs. 11%. All pts had normal values of STMs at PC-RPLA. PC RM from 2.1-5 cm and > 5 cm occurred in 52% and 55% pts, respectively. 15 pts (26%) received 2nd line C. Pts with no change or increasing nodal size and those with smaller reduction in nodal size following C were more likely to have T in the resected specimen. The 5- year (y) disease-specific survival (DSS) and relapsefree survival (RFS) rates were 97.6% and 87.5%. The 10-y DSS and RFS rates were 88.54% and 81.2% (log Rank=15.315; p<0.0001). By multivariate analysis T in the orchiectomy specimen (p<0.005), relative change in nodal size before and after C (p<0.005), and no requirement for 2nd line C (p=0.03) were independent predictors for the presence of the T in the RP. While IGCCCG risk classification was not significant predictor of T in the RP, there was a trend (p= 0.093) with intermediate/poor risk pts having a higher probability of RP T at PC-RPLA. Conclusions: T remains a common histological finding in RP LN following C. We have indentified pre-RPLA variables that predict the finding of T in the RP for men treated with C for metastatic NSTT.
Eur Urol Suppl 2011;10(9):644
C128
Long-term follow-up of cisplatin combination chemotherapy (C) in patients (pts) with disseminated nonseminomatous testicular tumors (NSTT): is a post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLA) needed after complete remission (CR)?
Argirović D.1, Argirović A.2 1 Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2Clinical Hospital Center Zemun-Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: Controversies arises regarding the optimal management of pts with NSTT who achieve a serologic and radiographic CR to systemic C. Some authors recommend PC-RPLA, whereas others omit surgery and observe these pts. In an attempt to address this question, we report long-term follow-up (FU) of pts who achieved a CR to 1st line C and were observed without PC-RPLA. Material & Methods: This is a retrospective analysis of 216 pts with metastatic NSTT who achieved a CR to 1st line C and were monitored without further therapy. CR was defined as normalization of STMs and complete resolution of all radiographic disease (ds). Results: Mean age was 27 year (y), teratoma (T) compound was present in the primary tumor in 82 (38%) pts, 54 (25%) pts were in CS III, and 79 (37%) pts had RP RM > 5 cm. 3 (1%) had < 2 y FU and 136 (63%) > 10 y. After a MFU of 160.3±62.2 months (m), 15 (7%) pts experienced relapse. Of these 15 pts, 9 pts currently have no evidence of ds (NED) and 6 pts died of ds. 8(4%) pts died while ds-free and 4(2%) died of unknown causes. The 5- , 10- y DSS and RFS rates were 90%, 88% and 84%,69%, respectively (Log Rank=37.25; p<0.0001). The 5- and 10-y overall survival rates were 90% and 84%, respectively. The 5-, 10-y DSS rates for good risk pts (n=159) vs intermediate/poor risk pts (n=57) were 99%, 95% and 99%, 93%, respectively (Log Rank=14.816; p<0.0001). Probability of remaining relapse free after achieving CR according to good vs intermediate/ poor IGCCCG risk group were 99% and 75%, respectively (Log Rank=16.015; p=0.001). 9 (6%) pts experienced recurrence in the RP within MFI of 29 m (range, 6 – 120 m), of whom 3 pts died of ds. 5 pts had late relapse (range, 25 – 120 m), including 3 pts in the RP. 3 pts currently have NED. On univariate analysis RP RM size and T in the orchiectomy specimen were not predictive for DSS, whereas the sole predictor was IGCCCG risk classification (p=0.001). 3(1%) pts had 2nd GCTT developed between 5 m to 17 y after initial diagnosis (all pts had CS I, with discordant histology, 2 underwent surveillance). Conclusions: Pts obtaining a CR after 1st line C can be safely observed without PC-RPLA. Relapses are rare and potentially curable with further treatment.
C129
Population-based study of perioperative mortality after retroperitoneal lymphadenectomy for nonseminomatous testicular tumors
Argirović D.1, Argirović A.2 1 Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2Clinical Hospital Center Zemun-Belgrade, Dept. of Urology, Belgrade, Serbia Introduction & Objectives: The present study is performed to determine wheter retroperitoneal lymphadenectomy (RPLA) perioperative mortality (PM) rates reported from a center of excellence [Indiana University: 0% for primary and 0.8% for postchemotherapy (PC) RPLA] are applicable to institution of large. Material & Methods: We used the data from 327 assessable pts with nonseminomatous testicular tumors (NSTT) treated with RPLA from 1975 to 2005 asseses from clinical data- base: primary in 134 pts (41%) and PC-RPLA in 193 pts (59%). The observed PM rates were stratified according to age, clinical stage (CS) and type of RPLA. Results: The median age at RPLA was 28 years (y)(range, 16-54):≤ 29 y in 184 (56.3%), 30-39 y in 99 (30.3%) and ≥ 40 y in 44 (13.4%) pts. Of 327 RPLA pts, 81 (27.8%) were performed for localized (CS-I), 179 (54.7%) for egional (CS-II) and 57 (17.5%) for metastatic (CS-III) disease (ds). 10 pts (3.1%) died during initial 90 days (d) after RPLA: 1 pt died of pulmonary embolism, 2 of C related toxicity and 7 of progressive ds due to perioperative worse prognostic factors. Of the entire cohort 30,60 and 90-d PM rate was 0.3%, 1.0% and 1.3%, respectively. PM rate increase with increasing age : ≥ 29y 0%, 30-39 y 5.0% and ≥ 40 y 11.4% (x2 trend test, p=0.002). PM also increased with increasing stage : 0% for localizd, 2.8% for regional and 8.8% for metastatic ds (x2 trend test, p<0.001). PM rate at primary vs PC-RPLA was 0.7% vs 3.1% (p<0.001). Conclusions: RPLA was associated with virtually no or low PM in pts with localized and regional ds. The PM rates from these 2 groups replicated those of Indiana University. In contrast, the PM rate of 8.8% for pts with distant metastases and group > 40 y of age (11.4%) implies that RPLA for these higher risk pts should be performed at centers of excellence, with intent of reducing the PM rate.