Retroperitoneal Lymph Node Dissection (RPLND) as an Alternative Local Control Strategy for Patients with Low-Volume, Clinical Stage II Testicular Seminoma: Patient Survey |
Introduction
Thank you for your time and interest. This survey should take no longer than 5 minutes to complete. Your responses are invaluable to us as we continue our work into investigating this issue.
Testicular cancer represents one of the true “success stories” for modern cancer treatment with almost all newly diagnosed patients being cured. With such successful outcomes, the focus has now turned to a reduction in the treatment’s side-effects. Within the group of testicular cancers, testicular seminoma is the most common sub-type. Since the cure rates in testicular seminoma approach 99%, there is great motivation to reduce the treatment-related side effects.
Approximately 5,000 adolescent and young adult men are diagnosed with testicular seminoma each year in the United States. Of this population, approximately 1,000 patients per year will have limited spread of the seminoma to the lymph nodes in the abdomen (retroperitoneal lymph nodes). Currently, the standard recommendation is to use radiation therapy (RT) to locally treat these lymph nodes because the cure rate is 90% with radiation alone and those who do recur after RT are nearly always cured with subsequent chemotherapy.
Unfortunately, the use of RT in this clinical situation is not without risks. We have observed a higher rate of long-term side effects in patients treated with RT, specifically an increased rate of secondary cancers. These cancers are not a recurrence of testicular seminoma, but a new, different cancer in other parts of the body thought to be due to the radiation exposure which was used to treat the seminoma which had spread to the retroperitoneal lymph nodes. Recent reviews have estimated that 15% of men treated with RT for this reason will experience a secondary cancer in the 25 years following RT.
We are interested in investigating the use of a different method of treating the retroperitoneal lymph nodes in this clinical situation. Specifically, this would be by surgical removal of these lymph nodes rather than by radiation to these nodes. The question is if surgery can provide an alternative to RT and reduce the exposure to long-term side effects while preserving the excellent chance for cure. This exact type of surgery is performed for other types of testicular cancer and substantial information exists on its side effects. Obviously, surgery has more short- and intermediate-term side effects than radiation, but these are mostly minor and self-limited. In terms of long-term effects, the comparison favors surgery over RT given that after the immediate recovery there are few side effects (Table I). Thus, while the effects of surgery and RT can be anticipated and explained to patients, a major hurdle to overcome prior to studying this strategy on a larger scale is that it has rarely been done in the specific setting of testicular seminoma. In total, there are 17 published cases of patients with low-volume, retroperitoneal-only, metastatic testicular seminoma who have been treated with surgical removal of the retroperitoneal lymph nodes. While these cases were all successful with no reports of disease recurrence, this limited evidence is insufficient for design of a larger clinical trial. In order to plan a clinical study, we are conducting this nation-wide survey of testicular cancer patients to identify their willingness to enroll in such a trial if they were hypothetically in this clinical scenario. Importantly, your responses are anonymous and in no way imply that you would be a patient in such a clinical trial in the future. We are only asking for your response to help us understand what percentage of patients would be interested in such a study.
Testicular cancer represents one of the true “success stories” for modern cancer treatment with almost all newly diagnosed patients being cured. With such successful outcomes, the focus has now turned to a reduction in the treatment’s side-effects. Within the group of testicular cancers, testicular seminoma is the most common sub-type. Since the cure rates in testicular seminoma approach 99%, there is great motivation to reduce the treatment-related side effects.
Approximately 5,000 adolescent and young adult men are diagnosed with testicular seminoma each year in the United States. Of this population, approximately 1,000 patients per year will have limited spread of the seminoma to the lymph nodes in the abdomen (retroperitoneal lymph nodes). Currently, the standard recommendation is to use radiation therapy (RT) to locally treat these lymph nodes because the cure rate is 90% with radiation alone and those who do recur after RT are nearly always cured with subsequent chemotherapy.
Unfortunately, the use of RT in this clinical situation is not without risks. We have observed a higher rate of long-term side effects in patients treated with RT, specifically an increased rate of secondary cancers. These cancers are not a recurrence of testicular seminoma, but a new, different cancer in other parts of the body thought to be due to the radiation exposure which was used to treat the seminoma which had spread to the retroperitoneal lymph nodes. Recent reviews have estimated that 15% of men treated with RT for this reason will experience a secondary cancer in the 25 years following RT.
We are interested in investigating the use of a different method of treating the retroperitoneal lymph nodes in this clinical situation. Specifically, this would be by surgical removal of these lymph nodes rather than by radiation to these nodes. The question is if surgery can provide an alternative to RT and reduce the exposure to long-term side effects while preserving the excellent chance for cure. This exact type of surgery is performed for other types of testicular cancer and substantial information exists on its side effects. Obviously, surgery has more short- and intermediate-term side effects than radiation, but these are mostly minor and self-limited. In terms of long-term effects, the comparison favors surgery over RT given that after the immediate recovery there are few side effects (Table I). Thus, while the effects of surgery and RT can be anticipated and explained to patients, a major hurdle to overcome prior to studying this strategy on a larger scale is that it has rarely been done in the specific setting of testicular seminoma. In total, there are 17 published cases of patients with low-volume, retroperitoneal-only, metastatic testicular seminoma who have been treated with surgical removal of the retroperitoneal lymph nodes. While these cases were all successful with no reports of disease recurrence, this limited evidence is insufficient for design of a larger clinical trial. In order to plan a clinical study, we are conducting this nation-wide survey of testicular cancer patients to identify their willingness to enroll in such a trial if they were hypothetically in this clinical scenario. Importantly, your responses are anonymous and in no way imply that you would be a patient in such a clinical trial in the future. We are only asking for your response to help us understand what percentage of patients would be interested in such a study.