Page 43 - Poster Sessions] CUA 2022 Annual Meeting Abstracts

2022 CUA ABSTRACTS

CUA 2022 Annual Meeting Abstracts – Poster Session 6: Oncology –

Penis/Testis/Urethra, Prostate

Saturday, June 25, 2022 • 16:00–17:30

Cite as: Can Urol Assoc J 2022;16(6Suppl1):S65-71. http://dx.doi.org/10.5489/cuaj.7928

MP-6.1 MP-6.2
Natural history of small testis masses The use of salvage chemotherapy for patients with relapsed
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James Hayes , Philippe Bedard , Eshetu Atenafu , Peter Chung , Di Maria testicular germ cell tumor in Canada: A national survey
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Jiang , Padraig Warde , Martin O’Malley , Lynn Anson-Cartwright , Rachel Esmail Al-Ezzi , Carlos Stecca , Robert J. Hamilton , Michael Crump , John
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Glicksman , Robert J. Hamilton 1 Kuruvilla , Lori A. Wood , Lucia Nappi , Christian Kollmannsberger , Scott
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1 Departments of Surgery (Urology) and Surgical Oncology, Princess North , Eric Winquist , Denis Soulieres , Sebastien Hotte , Srikala S. Sridhar ,
Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Di Maria Jiang 1
2 Division of Urology, Department of Surgery, University of Ottawa, Ottawa, 1 Division of Medical Oncology and Hematology, Princess Margaret Cancer
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ON, Canada; Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON,
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Centre, University Health Network, Toronto, ON, Canada; Department Canada; Division of Urology, Princess Margaret Cancer Centre, University
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of Biostatistics, Princess Margaret Cancer Centre, University Health Health Network, University of Toronto, Toronto, ON, Canada; Division of
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Network, Toronto, ON, Canada; Department of Radiation Oncology, Medical Oncology and Hematology, Queen Elizabeth II Health Sciences
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Princess Margaret Cancer Centre, University Health Network, Toronto, Centre, Dalhousie University, Halifax, NS, Canada; Department of
ON, Canada; Department of Medical Imaging, Princess Margaret Cancer Medicine, British Columbia Cancer Agency, University of British Columbia,
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Centre, University Health Network, Toronto, ON, Canada Vancouver, BC, Canada; Division of Medical Oncology, Cross Cancer
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Introduction: Increasing availability and sensitivity of ultrasound has led Institute, University of Alberta, Edmonton, AB, Canada; Department of
to burgeoning identification of small, non-palpable, intratesticular lesions. Oncology, London Health Sciences Centre, Western University, London,
While the overall rate of malignancy of testicular lesions is high at 80–90%, ON, Canada; Département Hématologie-Oncologie, Centre Hospitalier de
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for non-palpable lesions, the rate is much lower at 20%. Limited data exist l’Université de Montréal, Montreal, QC, Canada; Department of Oncology,
regarding the natural history and malignant potential of small testicular Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
masses. Introduction: Although metastatic germ cell tumor (GCT) is highly cur-
Methods: We retrospectively reviewed all scrotal ultrasounds performed able, 10% of patients relapse after initial cisplatin-based chemotherapy and
at the University Health Network in Toronto, Canada, between July 1996 have a poorer prognosis. Salvage chemotherapy options include conven-
and July 2015. In total, 2978 ultrasound reports met criteria and were tional (CDCT) and high-dose chemotherapy (HDCT). However, definitive
reviewed manually. Patients were included in the final cohort if they had comparative data are lacking. We aimed to characterize the contemporary
a non-cystic single or multifocal mass-like lesion(s) no larger than 1 cm. practice patterns of salvage chemotherapy across Canada.
Long-term followup was conducted by cross-referencing with provincial Methods: We conducted a 30-question online survey in August 2021 on
health information system Cancer Care Ontario data of all orchiectomies medical (MO) and hematological oncologists (HO) with experience in treat-
with a diagnosis of testis cancer with a minimum two-year followup period. ing GCT, assessing treatment availability, patient selection, and management
Results: In total, 116 met inclusion criteria, of whom only 15 (12.9%) were strategies used for relapsed GCT patients.
found to have testis cancer. Twenty-five (21.6%) underwent orchiectomy Results: Respondents were 24 staff MO, 2 HO, 2 both; from British
for clinical concern of testis cancer. Of those undergoing orchiectomy, Columbia, Alberta, Manitoba, Ontario, Quebec, New Brunswick, Nova
11 (42%) were benign and 14 (58%) were malignant. One patient was Scotia, and PEI; 86% were from academic centers. Reported case volumes
diagnosed on retroperitoneal biopsy. Several factors were associated with for salvage chemotherapy were <1 (18%), 1 (21%), 1–5 (39%), and 6–10
finding testis cancer at orchiectomy, including younger median age (29.98 cases/year (21%). No active clinical trials were available at the time of
vs. 50.83 years, p=0.0001), prior history of contralateral testis cancer (87% the survey. The most common CDCT regimens used were TIP (64%) and
vs. 2%, p<0.001), larger lesion size (6 mm vs. 4 mm, p=0.0015), multi- VIP (25%). HDCT was available for 70%, and used as first- (67%, range
focality (47% vs. 17%, p=0.0144), calcifications within the lesion (33.3% 0–100), second- (33%, 0–100) or third-line/beyond (4%, 0–20) salvage
vs. 3.96%, p=0.0017), and calcifications in the testicle in general (46.7% therapy. Only some used the IPFSG risk classification for treatment selec-
vs. 11.9%, p=0.003) (Table 1). tion. Assuming tolerability and feasibility, only one respondent indicated a
Conclusions: Our findings underscore that most small lesions are benign clinical scenario precluding HDCT (“rising markers during platinum chemo-
and reflexive; immediate radical orchiectomy may be overtreatment. In therapy for mediastinal non-seminoma”). HDCT regimen used included
select men, particularly in the absence of the above-noted risk factors, carboplatin and etoposide (two cycles 76%; three cycles 6%), and the
surveillance and/or partial orchiectomy is warranted. TICE protocol (two centers). “Bridging” CDCT was needed by 63% while
waiting to access HDCT. Post-HDCT treatments considered include surgical
resection for residual disease (n=13), maintenance etoposide (n=1), and
surveillance only (n=1).
Conclusions: HDCT is the most commonly used GCT salvage strategy in
Canada. Significant differences exist in the treatment availability, selection,
and delivery of HDCT, highlighting the need for standardization of care
for patients with relapsed testicular GCT requiring salvage chemotherapy.
CUAJ • June 2022 • Volume 16, Issue 6(Suppl1) S65
© 2022 Canadian Urological Association