observação - Simpósio Up To Date

Seminoma EC I Alto Risco
Qual a melhor conduta?
OBSERVAÇÃO
Franz Campos
Chefe do Serviço de Urologia
Instituto Nacional de Câncer
Seminoma I alto risco
DEFINIÇÃO
• > 4 cm
• Invasão de rete testis
Fig. 2. Effect of both 0, 1, or 2 adverse prognostic factors. Pooled
analysis. Relapse-free rate.
Warde P, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: A pooled analysis. J Clin Oncol 2002;20:4448 –52.
Observação: PubMed
Gary Mok, MD, Padraig Warde, MB, Princess Margaret Hospital, Toronto, Canada, Hematol Oncol Clin N Am 25 (2011) 503–516
Seminoma I: Tratamento
RXT
Dilema: Seguimento
5994 patients who were diagnosed and treated in the USA with CSIS between 1973 and 2000. The National
Cancer Institute’s Surveillance, Epidemiology and End Results (SEER).
“CSIS patients exposed to EBRT have a 19% increase in their risk of
developing an SPM compared to the general population, and have a
50% increase in SPMs compared to CSIS patients not exposed to
EBRT”.
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thyroid cancer (O/E, 2.32; 95% CI, 1.16 – 4.16)
pancreatic cancer (O/E, 2.38; 95% CI, 1.43 – 3.72)
non-bladder urothelial malignancies (O/E, 4.27; 95% CI, 1.57 – 9.29)
bladder cancer (O/E, 1.47; 95% CI, 1.01 – 2.28)
all haematological malignancies (O/E, 1.44; 95% CI, 1.08 – 1.89)
non-Hodgkin’s lymphoma (O/E, 1.77; 95% CI, 1.22 – 2.48)
METHODS: The National Cancer Data Base (NCDB) captures approximately 70% of all newly diagnosed cancers in the US.
RACIONAL PARA OBSERVAÇÃO
• 80% de tratamento desnecessário
• Resgate com Rxt e/ou QT
tumor altamente curável
• Tratamento adjuvante = efeitos adversos
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