NCCN Guidelines updated 10/16/06 V1.2007

[Karen]

http://www.nccn.org/professionals/physician_gls/PDF/testicular.pdf

Summary of changes in the 1.2007 version of the Testicular Cancer Guidelines from the 1.2006 version include:

Global Changes:
• The term "Observe" was changed to "Surveillance" throughout and RPLND was clarified as "open nerve-sparing".

Seminoma
• The recommendation to discuss sperm banking was added to the Primary Treatment section. The biopsy was clarified as an "open inguinal" biopsy and the ultrasound was defined as "suspicious for intratesticular abnormalities" .
• Stage IA, IB, IS: The RT recommendation was modified to include para-aortic ± ipsilateral iliac nodes. Single agent carboplatin was also added as a treatment option with a category 3 designation and supporting reference .
• Stage IIA, IIB: Consider EP x 4 cycles for selected stage IIB pages was added as a treatment option .
• For patients who have recurrence after RT or observation for Stage I or II disease, the recommendation is to treat according to the extent of disease at relapse .
• Stage IIB, IIC, III after primary treatment with chemotherapy: The CT scan was clarified to be of the chest, abdomen and pelvis. Serum tumor markers were added. The categories after the CT scan were modified to include marker status.
Footnote h is new to the page and includes recommendations for persistent, elevated beta-hCG but not rising .

Nonseminoma
• Footnote j is new throughout to the recommendation of RPLND, "Surgery is recommended within 4 weeks of CT scan, and 7-10 days of markers". This has a category 2B designation.
• aber nt lymphatic The terminology defining landing zone was modified to include "symptomatic" metastatic sites and " ra drainage".
• Footnote m, "There is limited predictive value for PET scan for residual masses" is new to the page .
• A note was added to the BEP regimen on page that some NCCN institutions administer bleomycin on a 2, 9, 16 day schedule.

[Scott]

Thanks for posting the update to this very important reference, Karen!

Single agent carboplatin was also added as a treatment option with a category 3 designation and supporting reference.

Note that "Category 3" means that "there is major NCCN disagreement that the recommendation is appropriate."

I also notice this new comment: "In general, an open nerve-sparing RPLND rather than a laparoscopic RPLND is recommended for therapeutic purposes. For example, a concern exists that a laparoscopic RPLND may result in false-negative results caused by inadequate sampling, and no published reports focus on the therapeutic efficacy of a laparoscopic dissection."

[dadmo]

Scott:
I don't know if this is the right spot for this question but if it needs to be moved that's easy enough. Let's forget that you had a problem with lymphatic fluid. How do you feel about you're LRPLND? Yes, it's less invasive, sure the scar is smaller but would the follow up stress be less with a full open as opposed to the Lap?

[Scott]

I believe it cured me. I also believe we should get on with the studies to prove it is effective.

[dadmo]

I agree more studies need to be done but I would love to see the LRPLND become the standard. I love to hear you say that you're cure.