Universität zu Köln

Heidenreich, Axel, Paffenholz, Pia, Nestler, Tim, Pfister, David and Daneshmand, Siamak (2020). Role of primary retroperitoneal lymph node dissection in stage I and low-volume metastatic germ cell tumors. Curr. Opin. Urol., 30 (2). S. 251 - 258. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1473-6586

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Abstract

Purpose of review Early-stage testicular cancers are highly curable. Following orchidectomy, management options for stage I disease include active surveillance, nerve-sparing retroperitoneal lymph node dissection (nsRPLND) and primary chemotherapy as recommended by the current guidelines. Primary RPLND has for decades played an integral part of treatment in patients with early-stage testicular germ cell tumors (TGCT), particularly in nonseminomatous germ cell tumors (NSGCT) with focus on reducing the long-term morbidity. We review the role of RPLND in stage I NSCGT as well as stage II A/B NSGCT and as seminoma. Recent findings Radiation therapy and systemic chemotherapy are established treatments for seminoma; however, long-term data has demonstrated the association of such therapies with late toxicity including secondary malignancies, hearing loss, cardiovascular disease as well as metabolic syndromes. Given the well established role of RPLND in NSGCTs, clinicians have developed an interest in utilization of surgery for low-volume retroperitoneal metastatic disease. Two prospective clinical trials (SEMS and PRIMETEST) are underway to determine the role of RPLND alone in low volume metastatic seminoma. RPLND is a highly effective treatment for early-stage germ cell tumors but represents overtreatment in low-volume stage I disease where active surveillance is recommended. RPLND has shown a promising role in low-volume stage II seminomas. Two phase II clinical trials are underway to further determine the curative potential of this approach.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Paffenholz, Pia UNSPECIFIED UNSPECIFIED UNSPECIFIED Nestler, Tim UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Daneshmand, Siamak UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-341904
DOI:	10.1097/MOU.0000000000000736
Journal or Publication Title:	Curr. Opin. Urol.
Volume:	30
Number:	2
Page Range:	S. 251 - 258
Date:	2020
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1473-6586
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MIDLINE EXTRAPERITONEAL APPROACH; NONSEMINOMATOUS TESTIS CANCER; CLINICAL STAGE; TESTICULAR CANCER; RISK-FACTORS; LYMPHADENECTOMY; CHEMOTHERAPY; MANAGEMENT; TERATOMA; RELAPSE Multiple languages Urology & Nephrology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34190