Baseline CT Scan After RPLND?

[MRMRSU]

National Comprehensive Cancer Network (NCCN - which includes a panel of TC doctors known to so many - Motzer, Sheinfeld, Jonasch just to name a few) says in its guidelines for follow-up for nonseminoma:

"Patients status post-RPLND, a postoperative baseline CT scan is recommended."

How soon after surgery is this baseline supposed to take place? Or is this the 6-month interval abdominal/pelvic CT scans that are supposed to happen Year One? Any clarification or links to other sites would be much appreciated by these newbies about to embark on surveillance-life after RPLND.

As always, thanks to you all.

[Lori]

Hi, I have no idea what the guidelines are but we had the CT Scan just prior to the RPLND and we had our next one in March. But Jon's schedule for CT Scans is every 4 months so I think the March scan simply coincided with that schedule. Hope your doing well!

[oscar666]

Hi

Well …I asked my doctor similar question.
Generally, we discussed about follow-up schedule after RPLND.
He said, regardless of guidelines, every case is different and frequency or type of tests could vary.
For me, he suggests Chest X-ray + blood work every 3-4 months (next 2 years).
CT scan and Scrotal Ultrasound tests are “optional” and they could be done later, but I have no date for them at this moment.
Again, these tests depend of many things like RPLND pathology results, type of RPLND itself (open, lap, primary or post-chemo, etc)
My opinion is that one of the biggest advantages of RPLND is exactly to eliminate the need of these frequent CT-scans.
That explains why the post-RPLND CT-scans are not so strictly defined in guidelines.

Peter.

[Vinny]

Here's what my onc did: stuck with the four-month schedule. I had a CT in late February 2005, one in April, then one right before the RPLND in May 2005 (IU insisted). RPLND was May 31. Next CT scan was in August, and we were back on the four-month plan.

[MRMRSU]

Hi Lori, Peter, Frank: Thanks for your time and for the info...it really is a bit hard to find the proper (if there even exists such a thing) guidelines. Urologist thought that next CT scan should be in late-October (6 months after RPLND), but he said to check with our oncologist. We see him next week. Many thanks again!

[fuse929]

it really is a bit hard to find the proper (if there even exists such a thing) guidelines.

This website may help you see some time-frames. http://www.nccn.org/professionals/p.../testicular.pdf

Bobby

[Vinny]

Urologist thought that next CT scan should be in late-October (6 months after RPLND), but he said to check with our oncologist.

Definitely go with what the oncologist thinks. When in surveillance mode, your oncologist is your PCP.

Good luck!

[Kev332]

Very interesting topic. Here is a quote from the TCRC website:

"CT scans are not to be taken lightly. They provide a reasonably large dose of radiation, and they should not be used if they are not needed. Our surveillance protocols do not call for abdominal CT scans post RPLND or post radiation. Studies have shown that the odds of a recurrence in the retroperitoneum are very small following these therapies, and these odds do not justify the use of a CT scan. However, these studies also assume that the RPLND was done correctly by a surgeon familiar with the operation. The nodes should have been removed as a package, not plucked out one by one. If this was not the case, then it probably makes sense to add CT scans to the post RPLND surveillance protocol."

[Margaret]

Very interesting topic. Here is a quote from the TCRC website:

"CT scans are not to be taken lightly. They provide a reasonably large dose of radiation, and they should not be used if they are not needed. Our surveillance protocols do not call for abdominal CT scans post RPLND or post radiation. Studies have shown that the odds of a recurrence in the retroperitoneum are very small following these therapies, and these odds do not justify the use of a CT scan. However, these studies also assume that the RPLND was done correctly by a surgeon familiar with the operation. The nodes should have been removed as a package, not plucked out one by one. If this was not the case, then it probably makes sense to add CT scans to the post RPLND surveillance protocol."

Interesting Kevin, Boyce will have 4 CT scans this year and he had a full bi-lateral RPLND done at SK.

[Lori]

Jon will have 3 CT scans of chest, abdomen and pelvis a year for 2 years, then go to 2 a year for 3 years. We were told by Dr. Einhorn this schedule was due to the amount of teratoma Jon had removed. The amount of radiation does unnerve us, but even more so, does the return of teratoma.

[dannysbrother]

The amount of radiation does unnerve us, but even more so, does the return of teratoma.

Lori, very good point.

Here's to hoping that will never ever ever happen.

-M

[MRMRSU]

A few more Q's

Thanks again everyone for your time...


Hi Kevin: So after your RPLND, what was your course of action? Any CT scans at all?

Hi Lori: When Jon's original pathology came back, did they tell you it was "immature" teratoma. It was in reading from the American Cancer Society website that we first even learned that there are different teratomas. How's everything been for Jon since RPLND?

[Kev332]

MRMRSU,

I actually did get CT scans after my RPLND, i think it was about 2 a year for the first two years, and then after discussing this topic here, I asked my Oncologist about it. He and said I was correct, and that they were just yielding on the safe side, however he agreed with me and I haven't had one since. =) I still go for routine blood work and chest x-rays every 6 months.

[MRMRSU]

Hi Kevin: Thanks for the post...do you remember how long after your RPLND you went in for your first CT scan?

[mstlyn]

Anthony had RPLND on June 8th and his post-op Ct scans are scheduled for this friday July 27th.