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Browsing by Author "Jewett, Michael A.S."
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Item Clinical dilemmas in local and regional testis cancer(Canadian Urological Association, 2021-01) Nason, Gregory J.; Rendon, Ricardo A.; Wood, Lori; Huddart, Robert A.; Albers, Peter; Einhorn, Lawrence H.; Nichols, Craig R.; Kollmannsberger, Christian; Anson-Cartwright, Lynn; Warde, Padraig; Jewett, Michael A.S.; Chung, Peter; Bedard, Philippe L.; Hansen, Aaron R.; Hamilton, Robert J.; Medicine, School of MedicineAt the Canadian Testis Cancer Workshop, the multidisciplinary management of testis cancer care was discussed. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician's assistants, residents, fellows, nurses, patients, and patient advocacy group members.This review summarizes the discussion regarding clinical dilemmas in local and regional testis cancer. We present cases that highlight the need for a coordinated approach to individualize care. Overarching themes include the importance of a multidisciplinary approach to testis cancer, willingness to involve a high-volume experienced center, and given that the oncological outcomes are excellent, a reminder that clinical decisions need to prioritize selecting a strategy with the least treatment-related morbidity when safe.Item Controversies in the management of clinical stage 1 testis cancer(Canadian Urological Association, 2020-11) Nason, Gregory J.; Chung, Peter; Warde, Padraig; Huddart, Robert; Albers, Peter; Kollmannsberger, Christian; Booth, Christopher M.; Hansen, Aaron R.; Bedard, Philippe L.; Einhorn, Lawrence; Nichols, Craig; Rendon, Ricardo A.; Wood, Lori; Jewett, Michael A.S.; Hamilton, Robert J.; Medicine, School of MedicineIn November 2018, The Canadian Testis Cancer Workshop was convened. The two-day workshop involved urologists, medical and radiation oncologists, pathologists, radiologists, physician’s assistants, residents and fellows, nurses, patients and patient advocacy groups. One of the goals of the workshop was to discuss the challenging areas of testis cancer care where guidelines may not be specific. The objective was to distill through discussion around cases, expert approach to working through these challenges. Herein we present a summary of discussion from the workshop around controversies in the management of clinical stage 1 (CS1) disease. CS1 represents organ confined non-metastatic testis cancer that represents approximately 70-80% of men at presentation. Regardless of management, CS1 has an excellent prognosis. However, without adjuvant treatment, approximately 30% of CS1 nonseminomatous germ cell tumors (NSGCT) and 15% of CS1 seminoma relapse. The workshop reviewed that while surveillance has become the standard for the majority of patients with CS1 disease there remains debate in the management of patients at high-risk of relapse. The controversy in the management of CS1 testis cancer surrounds the optimal balance between the morbidity of overtreatment and the identification of patients who may derive most benefit from adjuvant treatment. The challenge lies in a shared decision process where discussion of options extends beyond the simple risk of relapse but to include the long-term toxicities of adjuvant treatments and the favorable cancer-specific survival.Item Genetic Risk Assessment for Hereditary Renal Cell Carcinoma: Clinical Consensus Statement(Wiley, 2021) Bratslavsky, Gennady; Mendhiratta, Neil; Daneshvar, Michael; Brugarolas, James; Ball, Mark W.; Metwalli, Adam; Nathanson, Katherine L.; Pierorazio, Phillip M.; Boris, Ronald S.; Singer, Eric A.; Carlo, Maria I.; Daly, Mary B.; Henske, Elizabeth P.; Hyatt, Colette; Middleton, Lindsay; Morris, Gloria; Jeong, Anhyo; Narayan, Vivek; Rathmell, W. Kimryn; Vaishampayan, Ulka; Lee, Bruce H.; Battle, Dena; Hall, Michael J.; Hafez, Khaled; Jewett, Michael A.S.; Karamboulas, Christina; Pal, Sumanta K.; Hakimi, A. Ari; Kutikov, Alexander; Iliopoulos, Othon; Linehan, W. Marston; Jonasch, Eric; Srinivasan, Ramaprasad; Shuch, Brian; Urology, School of MedicineBackground: Although renal cell carcinoma (RCC) is believed to have a strong hereditary component, there is a paucity of published guidelines for genetic risk assessment. A panel of experts was convened to gauge current opinions. Methods: A North American multidisciplinary panel with expertise in hereditary RCC, including urologists, medical oncologists, clinical geneticists, genetic counselors, and patient advocates, was convened. Before the summit, a modified Delphi methodology was used to generate, review, and curate a set of consensus questions regarding RCC genetic risk assessment. Uniform consensus was defined as ≥85% agreement on particular questions. Results: Thirty-three panelists, including urologists (n = 13), medical oncologists (n = 12), genetic counselors and clinical geneticists (n = 6), and patient advocates (n = 2), reviewed 53 curated consensus questions. Uniform consensus was achieved on 30 statements in specific areas that addressed for whom, what, when, and how genetic testing should be performed. Topics of consensus included the family history criteria, which should trigger further assessment, the need for risk assessment in those with bilateral or multifocal disease and/or specific histology, the utility of multigene panel testing, and acceptance of clinician-based counseling and testing by those who have experience with hereditary RCC. Conclusions: In the first ever consensus panel on RCC genetic risk assessment, 30 consensus statements were reached. Areas that require further research and discussion were also identified, with a second future meeting planned. This consensus statement may provide further guidance for clinicians when considering RCC genetic risk assessment. Lay summary: The contribution of germline genetics to the development of renal cell carcinoma (RCC) has long been recognized. However, there is a paucity of guidelines to define how and when genetic risk assessment should be performed for patients with known or suspected hereditary RCC. Without guidelines, clinicians struggle to define who requires further evaluation, when risk assessment or testing should be done, which genes should be considered, and how counseling and/or testing should be performed. To this end, a multidisciplinary panel of national experts was convened to gauge current opinion on genetic risk assessment in RCC and to enumerate a set of recommendations to guide clinicians when evaluating individuals with suspected hereditary kidney cancer.