Safety of omitting pelvic imaging in patients with stage I germ cell tumor (GCT) on surveillance: A multi-institutional study.
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BACKGROUND AND OBJECTIVE: The preferred management of clinical stage I (CS1) germ cell tumor (GCT) is surveillance. Standard surveillance imaging protocols expose young patients to potential radiation-related consequences and have financial implications. We evaluated the safety of omitting routine pelvic imaging. METHODS: Patients with CS1 GCT electing surveillance at 3 major referral centers were included. "Pelvis only" recurrence was defined as those detectable solely on pelvic imaging below the bifurcation of common iliac vessels. Any inguinal recurrence detected on pelvic imaging was considered an "inguinal recurrence." Standard surveillance imaging protocols were used to estimate radiation dose reduction and cost saving per patient. RESULTS: A total of 285 patients were included. Forty-three patients (15%) had pelvic/inguinal nodal recurrence and 16/43 (37%) were detectable by imaging alone. However, in 11/16 (69%), pelvic/inguinal nodal disease was either visible on CT abdomen cuts (3) or there was simultaneous retroperitoneal recurrence (8). Only 5/285 (1.7%) patients had pelvis/inguinal recurrence only detectable on CT pelvis. Only 3/220 (1.3%) patients with no prior cryptorchidism or inguinal/scrotal surgery had pelvis only recurrence. The estimated reduction in radiation dose ranged between 2.31 and 3.46 mSv over 5 years with cost savings of 700 to 800 USD per patient. A limitation of the study includes variability in imaging protocols amongst the centers. CONCLUSION: Isolated pelvic/inguinal recurrence in CS1 GCT is rare and routine pelvic imaging appears to have limited value. Omitting CT pelvis could also reduce radiation exposure and offers cost-saving.