Management of testicular neoplasms in France and compliance with national guidelines
Monday, 29 March 2010- Testicular neoplasms (TN) are uncommon and for curable tumours with standardised treatment, guidelines are available. Treatments, however, may lead to adverse effects (long term severe toxicities, secondary cancer), occurring among young men.
N. Mottet and colleagues conducted a study to describe the primary TN management in France and to evaluate compliance with the national guidelines. They presented their findings during a general poster session at the recent ASCO 2010 Genitourinary Cancers Symposium held in San Francisco, California, USA.
Cases of TN diagnosed in 2003-2004 were identified from eleven general official exhaustive cancer registries. A detailed medical chart was used to collect individual data on tumor description and management. National guidelines published in 2002 were used as reference (Progrès en Urologie 2002;12:71-78).
A conformity list was defined by a group of experts. Each criterion could be in accordance with the recommendations, severely noncompliant (disagreement with the recommendations with a potential impact on outcome), marginally noncompliant (no effect on patient outcome), and noncompliant but justifiable (noncompliance explained by patient or tumour characteristics).
A total of 256 patients with testicular seminoma (TS) and 197 with testicular non-seminoma (TNS) were included: 69% had a stage I, 16% a stage II, 16% a stage III, and 11% an undetermined one. Globally only 10% of patients with TS and 12% with TNS received a totally conform management (all stages combined).
When restricting to therapeutic steps only, conformity to standard guideline was 44% and 28% respectively for TS and TNS. Most severe noncompliance are summarized in the Table.
"Based on exhaustive French cancer registries, the real life TN management is quite disappointing, specially for pretherapeutic step, surveillance for TNS, chemotherapy for TNS and TS, and postchemotherapy surgery," the researchers concluded.
They also said that the study highlights the need for larger guidelines diffusion on every contributor (pathologist, urologist, medical oncologist, and radiooncologist). “It might also be considered as a plea for patients' centralisation in reference centres,” they added.
TS | TNS | |
|---|---|---|
Tumour markers at diagnosis | 40% | 33% |
Histology report | 35% | 46% |
Radiotherapy | 31% | / |
Chemotherapy | 62% | 58% |
Active surveillance only | / | 95% |
Post-chemotherapy surgery | / | 70% |
Source: N. Mottet, S. Hoppe, et al., "Management of testicular neoplasms in France and compliance with national guidelines," Abstract 268, ASCO 2010 Genitourinary Cancers Symposium, San Francisco, California, USA.
