Localized testicular germ cell tumor (TGCT) surveillance: A Delphi consensus study.

Authors

null

Angélique DA Silva

Department of Medical Oncology, Centre François Baclesse, Caen, France

Angélique DA Silva , Aude Flechon , Stephane Culine , Elodie Coquan , Antoine Thiery Vuillemin , François Planchamp , Thibaut Murez , Arnaud Mejean , David Pasquier , Karim Fizazi , Florence Joly

Organizations

Department of Medical Oncology, Centre François Baclesse, Caen, France, Department of Medical Oncology, Centre Léon Bérard, Lyon, France, Department of Medical Oncology, Hospital Saint-Louis, Paris, France, Centre François Baclesse, Caen, France, Medical Oncology Unit, CHU Minjoz, Besançon, France, Clinical Research Unit, Institut Bergonié, Bordeaux, France, Department of Urology, Hôpital Lapeyronie, Montpellier, France, Department of Urology, Hôpital Européen Georges-Pompidou - Paris Descartes University, Paris, France, CRIStAL UMR CNRS 1189, Lille, France, Institut Gustave Roussy and University of Paris Sud, Villejuif, France

Research Funding

No funding received
None.

Background: Stage I testicular germ cell tumor (TGCT) has excellent cure rates and surveillance is fully included in patient’s management, particularly during the first years of follow-up. Surveillance guidelines differ between the academic societies, with different recommendations concerning clinical and imaging frequency de-escalation and long term follow-up. We evaluated surveillance practice and schedules followed by French specialists and set up a DELPHI method to obtain a consensual surveillance program with an optimal schedule for patients with localized TGCT. Methods: An online survey on surveillance practice of stage I TGCT based on clinical-cases was conducted among urologists, radiotherapists and oncologists. Results were compared to AFU, ESMO and EAU guidelines. Then a panel of experts assessed surveillance proposals following a formal consensus method (DELPHI method). Statements were drafted after analysis of the previous survey and systematic literature review, with 2 successive rounds to reach a consensus. Results: Survey and DELPHI were conducted between July 2018 and May 2019. Sixty-one (12.2%) participated to the survey (69% oncologists, 15% urologists, 16% radiotherapists). For the first 5 years of follow-up we observed 30 to 50% of adherence to AFU’s guidelines, 20 to 36% of adherence to ESMO’s guidelines and 6 to 45% of practices not corresponding to any of the guidelines depending on clinical situations. Only 25% of practitioners stopped surveillance after the 5th year, as recommended. No physician followed the ESMO guidelines of de-escalation chest imaging. For the Delphi study, a panel of 32 experts (78% oncologists, 16% urologists, 6% radiotherapists) was asked about 38 statements. Consensus was reached for 26 statements concerning clinico-biological surveillance modalities and end of surveillance after the 5th year of follow-up. For seminoma, abdominal ultrasound was proposed as an option to the abdominopelvic (AP) scan for the 4th year of follow-up. No consensus was reached regarding de-escalation of chest imaging. Conclusions: The survey proved that French TGCT specialists do not follow current guidelines. With DELPHI method, a consensus was obtained for frequency of clinico-biological surveillance, discontinuation of surveillance after the 5th year and stop of AP scan on the 4th year of follow-up for seminoma. Questions remains concerning type and frequency of chest imaging.

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Abstract Details

Meeting

2021 Genitourinary Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session: Adrenal, Penile, Testicular, and Urethral Cancers

Track

Adrenal Cancer,Penile Cancer,Testicular Cancer,Urethral Cancer

Sub Track

Quality of Care/Quality Improvement

Citation

J Clin Oncol 39, 2021 (suppl 6; abstr 384)

DOI

10.1200/JCO.2021.39.6_suppl.384

Abstract #

384

Poster Bd #

Online Only

Abstract Disclosures

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