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| SLIDES
& TRANSCRIPTS
Friday,
December 5, 2003
Management of Stage I Testis Cancer
Paul Lange, M.D. |
| Slide
1: |
 Now, so we can get on with the real speakers, I will go very quickly, but I am going to take 2 minutes to try to set the stage. And, of course, everyone in this room knows what is on this slide is basically the stage. That is, for a particularly high risk [group] is it [the treatment] surveillance, is it chemotherapy two courses or is it RPLND (retroperitoneal lymph node dissection)?
TOP
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| Slide
2: |
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 And, of course, when you think about the fact that we need to think about a variety of things, including the issue of monotherapy versus dual therapy, the cost and morbidity of that particular approach and the other one, what I would like the speakers to focus on, and I hope they will,
TOP |
| Slide
3: |
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 is whether the survival is the same with each of these modalities, both at the meccas and in local practice; and what are the morbidities, not so much the short morbidities but the long morbidities;
TOP |
| Slide
4: |
|  and is it true that we should go to any reasonable effort to avoid chemotherapy because of the unknown or the predicted problems long-term with chemotherapy because it is a poison? And if, in fact, certain assumptions are correct and these extrapolations are then correct, is it true that we can avoid chemotherapy and its long-term complications by doing a primary RPLND and save chemotherapy in 25 percent, particularly the heavy, the three course chemotherapy, and is that worth it?
TOP |
| Slide
5: |
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 And in order to do that, do we need to end up with this kind of patient [referring to the slide]? And I admit this is a little extreme, but it is a patient almost 30 years ago, and only George Bosl will recognize him.
TOP |
| Slide
6: |
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 Or do we end up with something like this
TOP |
| Slide
7: |
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[No text is associated with this slide]
TOP |
| Slide
8: |
|  And if we do, can we achieve the things in No. 1 and 2 [referring to the slide]? And of course to do that we have to watch N1 disease and if we find N1 disease at surgery are we compelled to do a bilateral dissection if we are going to give chemo for N2 disease? And can we achieve a bilateral dissection with a laparoscopic approach even in the best of hands?
TOP |
| Slide
9: |
|  A corollary to that is if we do not do a bilateral approach, what will be the long-term results with regard to cancer control? And do we need randomized or case-controlled studies to do that? And, of course, the last question is is this kind of technology transferable from the meccas to a local institution, or will the local regions defer to chemotherapy for political and economic reasons?
So, to begin this discussion, we will start off with our first speaker, who also needs no introduction, Joel Sheinfeld who will talk to us about RPLND. TOP |
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