Bilateral testicular germ cell tumors in patients treated for clinical stage I non-seminoma within two risk-adapted SWENOTECA protocols

Figures & data

Table I. Patients with previous metachronous or syncronous testicular cancer.

Type of bilateral	Initial treatment	Time since first GCT	Histology	Comments
Metachronous	Surveillance	11,2	Metachronous: SGCT	First TGCC was CS1 treated with adjuvant RT, 25.2 Gy. NR
Metachronous	Surveillance	7,5	Metachronous: NSGCT	First TGCC was CS2B, treated with BEP × 3 and RPLND
Metachronous	Surveillance	6.3	Metachronous: SGCT	First TGCC was CS1 treated with adjuvant RT, 25.2 Gy. NR
Metachronous	Surveillance	3,1	Metachronous: SGCT	First TGCC was CS1 treated with surveillance. NR
Metachronous	Surveillance	2,8	Metachronous: SGCT	First TGCC was CS1 treated with adjuvant RT, 27 Gy. NR
Metachronous	BEP × 1	3,6	Metachronous: SGCT	First TGCC was CS1 treated with adjuvant RT, 25.2 Gy. NR
Synchronous	Surveillance		Right: NSGCT Left: NSGCT	No relapse
Synchronous	Surveillance		Right: SGCT Left: NSGCT	Relapse at 5 years. Biopsy-verified SGCT. Treated with EP × 4
Synchronous	Surveillance		Right: NSGCT Left: NSGCT	No relapse
Synchronous	CVB × 1		Right: NSGCT Left: SGCT	No relapse
Synchronous	BEP × 1		Right: NSGCT Left: SGCT	No relapse
Synchronous	BEP × 1		Left: NSGCT Right: Scar	Suspected relapse due to elevated hCG. Received one course of BEP before right-side contralateral orchiectomy. No relapse
Synchronous	BEP × 1		Right: NSGCT Left: NSGCT	No relapse

BEP, bleomycin, etoposide and cisplatin; CVB, cisplatin, vinblastin and bleomycin; CS, clinical stage; EP, etopside and cisplatin; NSGCT, nonseminomatous germ cell testicular cancer; NR, no relapse; RT, radiotherapy; SGCT, seminomatous germ cell testicular cancer; TGCC, testicular germ cell cancer.

Figure 1. Consort diagram by biopsy status.

Figure 2. Consort diagram by treatment.

Table II. Metachronous bilateral germ cell cancers.

Intitial treatment	Time to new TGCC	Contralateral biopsy	CS	Histology	Comments
RPIND	0.2	ITGCNU	1	SGCT	Contralateral tumour detected before adjuvant RT was given. Most likely an undetected synchronous tumour. No relapse
Surveillance	0.9	ND	1	NSGCT	Metachronous followed by surveillance. No relapse
Surveillance	1.5	ND	2A	NSGCT	Relapse following surveillance, BEP× 4. Contralaleral diagnosed during salvage treatment. No further relapse
Surveillance	1.6	ND	1	Scar only	Due to elevated hCG received one course of BEP. Ultrasound revealed pathology, orchiectomy after one course of BEP show scar only. No relapse
BEP × l	1.6	ND	1	NSGCT	Metachronous treated with adjuvant BEP× 2. No relapse
BEP × l	1.8	No ITGCNU	1	NSGCT	Metachronous followed by surveillance. No relapse
Surveillance	1.8	ND	1	NSGCT	Metachronous followed by surveillance, No relapse
Surveillance	2.5	ND	1	NSGCT	Metachronous followed by surveillance. No relapse
BEP × l	2.6	ND	1	NSGCT	Metachronous followed by surveillance. No relapse
BEP × l	2.8	ND	1	SGCT	Metachronous treated with adjuvant carboplatin. No relapse
Surveillance	3.0	ND	1	NSGCT	Metachronous followed by surveillance. No relapse
BEP × l	3.1	ITGCNU	1	SGCT	RT 16 Gy given due to CIS. Still contralateral TGCC. Metachronous treated with surveillance. No relapse
BEP × l	4.2	No ITGCNU	1	NSGCT	Metachronous followed by surveillance. No relapse
Surveillance	4.2	No ITGCNU	2A	Burnt out	Metachronous treated with BEP× 3. Orehiectomy showed ITGCNU and burn out foci. No relapse
Surveillance	4.3	ND	1	SGCT	Metachronous followed by surveillance. No relapse
BEP × l	4.6	No ITGCNU	1	NSGCT	Metachronous followed by surveillance. No relapse
Surveillance	5.1	No ITGCNU	1	NSGCT	Metachronous followed by surveillance. No relapse
Surveillance	5.4	ND	1	NSGCT	Metachronous followed by surveillance. No relapse
BEP × l	5.6	ND	1	NSGCT	Metachronous followed by surveillance. No relapse
BEP × l	5.7	No ITGCNU	1	NSGCT	Metachronous followed by surveillance. No relapse
Surveillance	5.8	ND	1	NSGCT	Surveillance later relapse. BEP chemotherapy and RPLND (teratoma)
BEP × l	6.2	ND	1	NSGCT	Metachronous treated with adjuvant carboplatin. No relapse
Surveillance	7.3	ND	1	NSGCT	Metachronous treated with adjuvant BEP× 1. No relapse
CVB × 2	8.1	ND	1	SGCT	Metachronous followed by surveillance. No relapse

BEP, bleomycin, etoposide and cisplatin; CS, clinical stage; CVB, cisplatin, vinblastin and blemoycin; ITGCNU, intratubular germ cell neoplasia of unclassified type; NR, no relapse; ND, not done; NSGCT, nonseminomatous germ cell testicular cancer; RPLND, retroperitoneal lymph node dissection; RT, radiotherapy; SGCT, seminomatous germ cells testicular cancer; TGCC, testicular germ cell cancer.

Table III. Possible prognostic factors, development of contralateral testicular cancer.

Risk factor	Singel variable model
	RR (95% CI)	p-value
LVI-	0.69 (0.31–1.55)	0.36
ACT not given	1.40 (0.63–3.14)	0.41
Biopsy not performed	0.80 (0.34–1.86)	0.60
Age at orchiectomy	0.93 (0.88–0.99)	0.02

ACT, adjuvant chemotherapy; CI, confidence interval; LVI, lymfovascular invasion; NI, not include; RR, relative risk. Estimated RR and p values estimated from Cox proportional hazards models.