{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:58:15Z","timestamp":1782316695092,"version":"3.54.5"},"reference-count":40,"publisher":"Elsevier BV","issue":"7","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"content-domain":{"domain":["annalsofoncology.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Annals of Oncology"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1016\/j.annonc.2026.04.005","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T20:31:50Z","timestamp":1776285110000},"page":"880-885","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"title":["A simple plan: chemotherapy-sparing approaches to early-stage and regional seminoma and nonseminoma"],"prefix":"10.1016","volume":"37","author":[{"given":"L.","family":"Nappi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-1761","authenticated-orcid":false,"given":"A.","family":"Thor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Tandstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Heidenreich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2712-3663","authenticated-orcid":false,"given":"D.","family":"Escobar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"D'Souza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Einhorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Adra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Cary","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Masterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Kollmannsberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.J.","family":"Hamilton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Ozgun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5258-4130","authenticated-orcid":false,"given":"C.","family":"Conduit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.L.","family":"Harzstark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Daugaard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1747-9615","authenticated-orcid":false,"given":"P.","family":"Albers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Eggener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Kern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6068-9474","authenticated-orcid":false,"given":"K.","family":"Fizazi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Bagrodia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Nicolai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Palmieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5360-2820","authenticated-orcid":false,"given":"F.E.","family":"Millard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.J.","family":"Roth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Daneshmand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Nichols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"9","key":"10.1016\/j.annonc.2026.04.005_bib2","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1111\/j.1464-410X.2005.05504.x","article-title":"The changing presentation of germ cell tumours of the testis between 1983 and 2002","volume":"95","author":"Powles","year":"2005","journal-title":"BJU Int"},{"issue":"28","key":"10.1016\/j.annonc.2026.04.005_bib3","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.1200\/JCO.2014.56.0896","article-title":"Testicular cancer: a reflection on 50 years of discovery","volume":"32","author":"Hanna","year":"2014","journal-title":"J Clin Oncol"},{"issue":"5","key":"10.1016\/j.annonc.2026.04.005_bib4","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s11912-023-01375-8","article-title":"Cardiovascular risks in testicular cancer: assessment, prevention, and treatment","volume":"25","author":"Clasen","year":"2023","journal-title":"Curr Oncol Rep"},{"issue":"32","key":"10.1016\/j.annonc.2026.04.005_bib5","doi-asserted-by":"crossref","first-page":"3561","DOI":"10.1200\/JCO.21.00637","article-title":"Testicular cancer in the cisplatin era: causes of death and mortality rates in apopulation-based cohort","volume":"39","author":"Hellesnes","year":"2021","journal-title":"JCO"},{"key":"10.1016\/j.annonc.2026.04.005_bib6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ejca.2021.06.022","volume":"155","author":"Hiester","year":"2021","journal-title":"Eur J Cancer"},{"issue":"30","key":"10.1016\/j.annonc.2026.04.005_bib7","doi-asserted-by":"crossref","first-page":"3807","DOI":"10.1200\/JCO.2013.50.3409","article-title":"Solid tumors after chemotherapy or surgery for testicular nonseminoma: a population-based study","volume":"31","author":"Fung","year":"2013","journal-title":"JCO"},{"issue":"21","key":"10.1016\/j.annonc.2026.04.005_bib8","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.1200\/JCO.2011.34.6379","article-title":"Association of diagnostic radiation exposure and second abdominal-pelvic malignancies after testicular cancer","volume":"29","author":"Van Walraven","year":"2011","journal-title":"JCO"},{"issue":"16","key":"10.1016\/j.annonc.2026.04.005_bib9","doi-asserted-by":"crossref","first-page":"3009","DOI":"10.1200\/JCO.22.00624","article-title":"Surgery in early metastatic seminoma: a phase II trial of retroperitoneal lymph node dissection for testicular seminoma with limited retroperitoneal lymphadenopathy","volume":"41","author":"Daneshmand","year":"2023","journal-title":"JCO"},{"issue":"23","key":"10.1016\/j.annonc.2026.04.005_bib10","doi-asserted-by":"crossref","first-page":"3930","DOI":"10.1200\/JCO.22.01822","article-title":"Primary retroperitoneal lymph node dissection for stage II seminoma: is surgery the new path forward?","volume":"41","author":"Tachibana","year":"2023","journal-title":"JCO"},{"issue":"3","key":"10.1016\/j.annonc.2026.04.005_bib11","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.ucl.2024.03.010","article-title":"Regionalization of testis cancer care\u2014is it necessary?","volume":"51","author":"Heidenreich","year":"2024","journal-title":"Urol Clin North Am"},{"key":"10.1016\/j.annonc.2026.04.005_bib12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1200\/CCI.20.00114","article-title":"Implementation of a multidisciplinary expert testicular cancer tumor board across a large integrated healthcare delivery system via early case ascertainment","volume":"5","author":"Harzstark","year":"2021","journal-title":"JCO Clin Cancer Inform"},{"key":"10.1016\/j.annonc.2026.04.005_bib13","doi-asserted-by":"crossref","first-page":"703","DOI":"10.2147\/CLEP.S99493","article-title":"The Danish Testicular Cancer database","volume":"8","author":"Daugaard","year":"2016","journal-title":"Clin Epidemiol"},{"issue":"1","key":"10.1016\/j.annonc.2026.04.005_bib14","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3109\/21681805.2015.1059360","article-title":"The SWENOTECA group: a good example of continuous binational and multidisciplinary collaboration for patients with testicular cancer in Sweden and Norway","volume":"50","author":"Tandstad","year":"2016","journal-title":"Scand J Urol"},{"issue":"10","key":"10.1016\/j.annonc.2026.04.005_bib15","first-page":"346","article-title":"A Canadian approach to the regionalization of testis cancer: a review","volume":"14","author":"Nason","year":"2020","journal-title":"Can Urol Assoc J"},{"issue":"6_suppl","key":"10.1016\/j.annonc.2026.04.005_bib16","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1200\/JCO.2020.38.6_suppl.396","article-title":"WATChmAN: a randomized trial of virtual surveillance versus standard in-person care for clinical stage I testicular cancer","volume":"38","author":"Hamilton","year":"2020","journal-title":"JCO"},{"issue":"1","key":"10.1016\/j.annonc.2026.04.005_bib17","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.eururo.2022.10.021","article-title":"Phase 2 single-arm trial of primary retroperitoneal lymph node dissection in patients with seminomatous testicular germ cell tumors with clinical stage IIA\/B (PRIMETEST)","volume":"84","author":"Hiester","year":"2023","journal-title":"Eur Urol"},{"issue":"1","key":"10.1016\/j.annonc.2026.04.005_bib18","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.euo.2023.06.004","article-title":"Retroperitoneal lymph node dissection in clinical stage IIA\/B metastatic seminoma: results of the COlogne Trial of Retroperitoneal Lymphadenectomy In Metastatic Seminoma (COTRIMS)","volume":"7","author":"Heidenreich","year":"2024","journal-title":"Eur Urol Oncol"},{"key":"10.1016\/j.annonc.2026.04.005_bib41","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.euros.2024.05.006","article-title":"Primary retroperitoneal lymph node dissection as treatment for low-volume metastatic seminoma in a population-based cohort: the Swedish Norwegian testicular cancer group Experience","volume":"65","author":"Thor","year":"2024","journal-title":"Eur Urol Open Sci"},{"issue":"1","key":"10.1016\/j.annonc.2026.04.005_bib19","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/JU.0000000000003697","article-title":"Primary retroperitoneal lymph node dissection for seminoma metastatic to the retroperitoneum","volume":"211","author":"Matulewicz","year":"2024","journal-title":"J Urol"},{"issue":"4","key":"10.1016\/j.annonc.2026.04.005_bib20","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1111\/bju.16448","article-title":"Primary retroperitoneal lymph node dissection for metastatic non-seminomatous germ cell tumours: outcomes and adjuvant chemotherapy","volume":"134","author":"Mousa","year":"2024","journal-title":"BJU Int"},{"issue":"32","key":"10.1016\/j.annonc.2026.04.005_bib21","doi-asserted-by":"crossref","first-page":"3762","DOI":"10.1200\/JCO.22.00118","article-title":"Primary retroperitoneal lymph node dissection for patients with pathologic stage II nonseminomatous germ cell tumor\u2014N1, N2, and N3 disease: is adjuvant chemotherapy necessary?","volume":"40","author":"Tachibana","year":"2022","journal-title":"JCO"},{"issue":"4","key":"10.1016\/j.annonc.2026.04.005_bib22","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1111\/bju.16618","article-title":"Primary retroperitoneal lymph node dissection in clinical stage 2a\/b non-seminomatous germ cell tumour","volume":"135","author":"Antonelli","year":"2024","journal-title":"BJU Int"},{"issue":"12","key":"10.1016\/j.annonc.2026.04.005_bib23","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1200\/JCO.19.02712","article-title":"Adjuvant chemotherapy with etoposide plus cisplatin for patients with pathologic stage II nonseminomatous germ cell tumors","volume":"38","author":"McHugh","year":"2020","journal-title":"JCO"},{"issue":"4","key":"10.1016\/j.annonc.2026.04.005_bib24","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1177\/03008916221112697","article-title":"Retroperitoneal lymph-node dissection (RPLND) as upfront management in stage II germ-cell tumours: Evaluation of safety and efficacy","volume":"109","author":"Nicolai","year":"2023","journal-title":"Tumori"},{"issue":"22","key":"10.1016\/j.annonc.2026.04.005_bib25","doi-asserted-by":"crossref","first-page":"1856","DOI":"10.1200\/JCO.19.00502","article-title":"Management of stage II germ cell tumors: be sure, be patient, be safe","volume":"37","author":"Kollmannsberger","year":"2019","journal-title":"JCO"},{"issue":"6","key":"10.1016\/j.annonc.2026.04.005_bib26","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.eururo.2014.07.001","article-title":"A nationwide cohort study of stage I seminoma patients followed on a surveillance program","volume":"66","author":"Mortensen","year":"2014","journal-title":"Eur Urol"},{"issue":"1","key":"10.1016\/j.annonc.2026.04.005_bib27","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1200\/JCO.2014.56.2116","article-title":"Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance","volume":"33","author":"Kollmannsberger","year":"2015","journal-title":"JCO"},{"issue":"3","key":"10.1016\/j.annonc.2026.04.005_bib28","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/S0022-5347(01)65063-8","article-title":"Are 3 cycles of bleomycin, etoposide and cisplatin or 4 cycles of etoposide and cisplatin equivalent optimal regimens for patients with good risk metastatic germ cell tumors of the testis? The need for a randomized trial","volume":"157","author":"Culine","year":"1997","journal-title":"J Urol"},{"issue":"5","key":"10.1016\/j.annonc.2026.04.005_bib29","doi-asserted-by":"crossref","first-page":"1837","DOI":"10.1200\/JCO.1997.15.5.1837","article-title":"Importance of bleomycin in combination chemotherapy for good-prognosis testicular nonseminoma: a randomized study of the European Organization for Research and Treatment of Cancer Genitourinary Tract Cancer Cooperative Group","volume":"15","author":"De Wit","year":"1997","journal-title":"JCO"},{"issue":"9","key":"10.1016\/j.annonc.2026.04.005_bib30","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1038\/s41416-018-0300-x","article-title":"Development of a best-practice clinical guideline for the use of bleomycin in the treatment of germ cell tumours in the UK","volume":"119","author":"Watson","year":"2018","journal-title":"Br J Cancer"},{"issue":"6","key":"10.1016\/j.annonc.2026.04.005_bib31","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/onco.13719","article-title":"Four cycles of etoposide plus cisplatin for patients with good-risk advanced germ cell tumors","volume":"26","author":"Funt","year":"2021","journal-title":"Oncologist"},{"issue":"3","key":"10.1016\/j.annonc.2026.04.005_bib32","doi-asserted-by":"crossref","first-page":"81","DOI":"10.6004\/jnccn.2025.7120","article-title":"Renal impairment and late toxicities comparing contemporary chemotherapy regimens for testicular cancer in a real-world setting","volume":"24","author":"Kerns","year":"2026","journal-title":"J Natl Compr Canc Netw"},{"issue":"5","key":"10.1016\/j.annonc.2026.04.005_bib33","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1093\/annonc\/mdm062","article-title":"Refining the optimal chemotherapy regimen for good-risk metastatic nonseminomatous germ-cell tumors: a randomized trial of the Genito-Urinary Group of the French Federation of Cancer Centers (GETUG T93BP)","volume":"18","author":"Culine","year":"2007","journal-title":"Ann Oncol"},{"issue":"2","key":"10.1016\/j.annonc.2026.04.005_bib34","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.juro.2014.09.090","article-title":"The impact of bleomycin on retroperitoneal histology at post-chemotherapy retroperitoneal lymph node dissection of good risk germ cell tumors","volume":"193","author":"Cary","year":"2015","journal-title":"J Urol"},{"issue":"16","key":"10.1016\/j.annonc.2026.04.005_bib35","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1093\/jnci\/djq266","article-title":"Alternatives to standard BEP x 3 in good-prognosis germ cell tumors--you bet your life","volume":"102","author":"Nichols","year":"2010","journal-title":"J Natl Cancer Inst"},{"issue":"12","key":"10.1016\/j.annonc.2026.04.005_bib36","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1001\/jamaoncol.2018.4316","article-title":"Reassessment of 4-cycle etoposide and cisplatin as the standard of care for good-risk metastatic germ cell tumors","volume":"4","author":"Fein","year":"2018","journal-title":"JAMA Oncol"},{"issue":"22","key":"10.1016\/j.annonc.2026.04.005_bib37","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1200\/JCO.18.01250","article-title":"Treatment of relapse of clinical stage I nonseminomatous germ cell tumors on surveillance","volume":"37","author":"Hamilton","year":"2019","journal-title":"JCO"},{"issue":"5","key":"10.1016\/j.annonc.2026.04.005_bib38","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1097\/01.ju.0000060960.18092.54","article-title":"Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group","volume":"169","author":"Heidenreich","year":"2003","journal-title":"J Urol"},{"issue":"1","key":"10.1016\/j.annonc.2026.04.005_bib39","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/MOU.0000000000001137","article-title":"MicroRNAs for detecting occult genitourinary cancer","volume":"34","author":"Tavares","year":"2024","journal-title":"Curr Opin Urol"},{"issue":"31","key":"10.1016\/j.annonc.2026.04.005_bib40","doi-asserted-by":"crossref","first-page":"3525","DOI":"10.1200\/JCO.2017.73.4723","article-title":"Practice makes perfect: the rest of the story in testicular cancer as a model curable neoplasm","volume":"35","author":"Tandstad","year":"2017","journal-title":"JCO"}],"container-title":["Annals of Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0923753426001432?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0923753426001432?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T15:45:26Z","timestamp":1782315926000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0923753426001432"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":40,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["S0923753426001432"],"URL":"https:\/\/doi.org\/10.1016\/j.annonc.2026.04.005","relation":{},"ISSN":["0923-7534"],"issn-type":[{"value":"0923-7534","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"A simple plan: chemotherapy-sparing approaches to early-stage and regional seminoma and nonseminoma","name":"articletitle","label":"Article Title"},{"value":"Annals of Oncology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.annonc.2026.04.005","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"simple-article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 European Society for Medical Oncology. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}]}}