Interdisciplinary evidence-based recommendations for the follow-up of early stage seminomatous testicular germ cell XXXX @entity1 .

@entity5 @entity3003 @entity1 @entity4797
PURPOSE: To provide guidance regarding follow-up procedures after initial treatment of early stage @entity4797 (clinical stages (CS) I-II A/B) based on current published evidence complemented by expert opinion. METHODS AND MATERIAL: An interdisciplinary, multinational working group consisting of urologists, medical oncologists, and radiation oncologists analyzed the published evidence regarding follow-up procedures in various stages of seminomatous and nonseminomatous @entity5 . Focusing on radiooncological aspects, the recommendations contained herein are restricted to early stage @entity4797 (with radiotherapy being a standard treatment option). In particular, extent, frequency, and duration of imaging at follow-up were analyzed concerning relapse patterns, risk factors, and mode of relapse detection. RESULTS: Active surveillance, adjuvant @entity3003 or radiotherapy are equally accepted options for CS I @entity4797 but they result in different relapse rates and patterns. Usually relapses occur within the first 2(-6) years. Routinely performed follow-up using computerized tomography (CT) after adjuvant treatment yield only low detection rates of recurrences. Therefore, there is no evidence to maintain routine examinations every 3-4 months. After treatment of stage IIA/B, detection rates of relapses or progression identified solely by routinely performed CT during follow-up are low. CONCLUSION: Considering lifelong cure rates of up to 99% for @entity1 treated for @entity4797 CS I-IIA/B, the negative impact of unnecessary ionizing radiation exposure has to be considered. The presented recommendations for various follow-up scenarios for early stage @entity4797 strongly promote the restrictive use of imaging procedures that utilize ionizing radiation (especially CT), due to its potential to induce secondary @entity5 .
