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Actual frequency of imaging during follow-up of testicular cancer in Israel—a comparison with the guidelines

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Computed tomography (CT) examinations are frequent in follow-up care of testicular cancer (TC) but may increase the risk for other cancers. We wanted to assess the actual number of CT and X-ray examinations within the first 5 years after a diagnosis of TC in Israel during 2003–2007.

Methods

The database of Maccabi Healthcare Services, Israel, was searched for TC patients diagnosed in 2003 to 2007 by direct linkage with the Israel National Cancer Registry. Data on diagnostic imaging examinations (CT of chest, abdomen, or pelvis, unspecified sites; X-ray of chest) were extracted during a 5-year follow-up for 226 incident patients. The actual number of CT and X-ray examinations was compared to the National Comprehensive Cancer Network (NCCN) guideline. We tabulated the median with 10th and 90th percentiles (P10, P90) for the number of CTs and X-rays considering histology, stage, and adjuvant strategy.

Results

The number of abdomen or pelvis CTs for TC patients receiving chemo- or radiotherapy was in accordance with the NCCN guideline. The median of abdomen or pelvis CTs for surveillance patients was 8.5 (P10, P90: 3; 13) for nonseminoma and 5.0 (P10, P90: 5; 13) for seminoma patients compared to 14 to 17 CTs recommended. The number of chest X-rays was lower than recommended in the guideline for all adjuvant strategies.

Conclusions

The NCCN guidelines regarding CTs were met for TC patients treated with chemo- or radiotherapy but fell below recommendations for surveillance. Guidelines from 2011 and 2012 were updated in favor of fewer CTs during surveillance.

Key Points

• The number of CTs followed the NCCN guidelines in patients treated with chemo- or radiotherapy.

• Surveillance patients received fewer CTs and X-rays than recommended in the NCCN guidelines from 2005.

• The number of applied CT examinations corresponded to a radiation dose that did not substantially raise the lifetime risk for cancer.

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Abbreviations

ALARA:

As low as reasonably achievable

AYAS:

Adolescents and young adults

BEIR:

Biological Effects of Ionizing Radiation

CI5C:

Cancer in Five Continents

CT:

Computed tomography

CTX:

Chemotherapy

EAU:

European Association of Urology

FDG-PET:

Fluorodeoxyglucose positron emission tomography

ICD-O:

International Classification of Diseases for Oncology

INCR:

Israel National Cancer Registry

IQR:

Interquartile range

LAR:

Lifetime attributable risk

MHS:

Maccabi Healthcare Services

MRI:

Magnetic resonance imaging

NCCN:

National Comprehensive Cancer Network

RTX:

Radiotherapy

TC:

Testicular cancer

US:

Ultrasound

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Acknowledgements

We thank Eva Bock for her support in the data management and Adi Rennert for her support in organization.

Funding

This study has received funding from the Deutsche Forschungsgemeinschaft (DFG) (grant number RU 1659/4-1) and the Federal Ministry of Education and Research (BMBF) (grant number 01ER1704).

Author information

Author notes

  1. Anna-Therese Lehnich and Carsten Rusner contributed equally to this work.

Authors and Affiliations

  1. Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany

    Anna-Therese Lehnich & Andreas Stang

  2. Radiology Office, Hospital St. Elisabeth and St. Barbara, Mauerstraße 5, 06110, Halle, Germany

    Carsten Rusner

  3. Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Ramat Aviv, 69978, Tel Aviv, Israel

    Gabriel Chodick

  4. Maccabitech, Maccabi Healthcare Services, Ottoman Society No. 227/99, Of 27 Hamered Street, Tel Aviv, Israel

    Gabriel Chodick, Rachel Katz & Tal Sella

  5. Department of Medical Oncology, Dana-Faber Cancer Institute, 450 Brookline Ave, Boston, MA, USA

    Tal Sella

  6. School of Public Health, Department of Epidemiology, Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA

    Andreas Stang

  7. German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Andreas Stang

  8. Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Hufelandstr. 55, 45147, Essen, Germany

    Andreas Stang

Authors
  1. Anna-Therese Lehnich
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Corresponding author

Correspondence to Anna-Therese Lehnich.

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The scientific guarantor of this publication is Prof. Dr. med. Andreas Stang, MPH.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Lehnich, AT., Rusner, C., Chodick, G. et al. Actual frequency of imaging during follow-up of testicular cancer in Israel—a comparison with the guidelines. Eur Radiol 29, 3918–3926 (2019). https://doi.org/10.1007/s00330-019-06148-1

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  • DOI: https://doi.org/10.1007/s00330-019-06148-1

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