Testicular Cancer Research
The Department of Urology at Indiana University School of Medicine is one of the world’s largest centers for the management of patients with testicular cancer. The surgical approach to the disease was pioneered at IU School of Medicine several decades ago and modifications have continued over time to improve patient care and outcomes. Through continued collaboration with the medical oncology, thoracic and general surgery divisions, faculty physicians are able to provide a comprehensive approach to patient care. Their research in testicular cancer is focused on lowering morbidity and improving patient outcomes.
Faculty researchers are working to understand pulmonary and operative morbidity following postchemotherapy retroperitoneal lymph node dissection with and without the use of bleomycin chemotherapy. Researchers have demonstrated there is no increased surgical risk when patients receive bleomycin prior to surgery, despite other centers speculating about this concern. This work was published in the Journal of Clinical Oncology.
Researchers are studying ways to improve postoperative pain and length of stay following retroperitoneal lymph node dissection (RPLND) by using newer pain regimens and medications to maintain normal bowel function to lower postoperative pain and shorten hospital stays. This is the largest study ever conducted in this patient population and demonstrated decreased pain scores and shorter hospital stays by using this new medication regimen.
The main goal of this project is to ensure IU School of Medicine faculty physicians continue to build upon the work they have done over the past 40 years with this surgery as well as to quantify how often physicians cure patients with surgery alone when found to have metastatic disease. This offers the benefit to patients of avoiding chemotherapy when possible.
The department is researching certain subpopulations of testis cancer, such as studying patients who present with extremely high beta hCG tumor marker blood levels, understanding surgical outcomes in patients with non-germ cell testicular cancers such as Leydig cell or Sertoli cell tumors, and predicting teratoma in the retroperitoneum after chemotherapy based on the percentage of teratoma in the testicle at the time of initial diagnosis.
Department of Urology researchers are participating in the multi-institutional surgery in early metastatic seminoma (SEMS) trial. IU School of Medicine is the highest enrolling center for this trial in the United States. This trial seeks to help researchers understand if surgery is an option in patients with low volume metastatic seminoma in hopes to avoid either chemotherapy or radiation.
Researchers are currently collecting biospecimens to validate a new potential marker for germ cell tumors, micro RNA 371. This is a promising new biomarker in this population that may hold predictive characteristics. This is currently being evaluated in patients with clinical stage I and advanced disease.
Albany C, Adra N, Snavely AC, et al: Multidisciplinary clinic approach improves overall survival outcomes of patients with metastatic germ-cell tumors. Ann Oncol 2017; 29: 341–346.
Cary C, Jacob JM, Albany C, et al: Long-Term Survival of Good-Risk Germ Cell Tumor Patients After Postchemotherapy Retroperitoneal Lymph Node Dissection: A Comparison of BEP × 3 vs. EP × 4 and Treating Institution. Clin Genitourin Cancer 2018; 16: e307–e313.
Cary C, Pedrosa JA, Jacob JM, et al: Outcomes of postchemotherapy retroperitoneal lymph node dissection following high-dose chemotherapy with stem cell transplantation. Cancer 2015; 121: 4369–4375.
Cary C, Masterson TA, Bihrle R, et al: Contemporary trends in postchemotherapy retroperitoneal lymph node dissection: Additional procedures and perioperative complications. Urol Oncol 2015; 33: 389.e15–21.
Liu N, Cary C, Strine AC, et al: Risk of Recurrence for Clinical Stage I and II Patients with Teratoma Only at Primary Retroperitoneal Lymph Node Dissection. Urology 2015; 86: 981–984.
Cary C, Pedrosa JA, Kaimakliotis HZ, et al: The impact of bleomycin on retroperitoneal histology at post-chemotherapy retroperitoneal lymph node dissection of good risk germ cell tumors. J Urol 2015; 193: 507–512.
Cho JS, Kaimakliotis HZ, Cary C, et al: Modified retroperitoneal lymph node dissection for post-chemotherapy residual tumour: a long-term update. BJU Int 2017; 128: 315–5.
Giannatempo P, Pond GR, Sonpavde G, et al: Treatment and Clinical Outcomes of Patients with Teratoma with Somatic-Type Malignant Transformation: An International Collaboration. J Urol 2016; 196: 95–100.