Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Hospital de Sant Pau, Barcelona; Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet; Hospital Universitari Sant Joan, Reus; Hospital Clínico Universitario Virgen de la Victoria, Málaga; Hospital Universitari Germans Trias i Pujol, Badalona; Hospital Althaia, Manresa; Hospital Mutua de Terrassa, Terrassa; Complejo Hospitalario Universitario, Albacete; Hospital Universitario Marqués de Valdecilla, Santander; Hospital Son Dureta, Palma de Mallorca; Hospital General, Alicante; Hospital de Basurto, Bilbao; Hospital Clínico San Carlos, Madrid; Instituto Oncológico de Guipúzcoa, San Sebastián; Hospital Luis Alcañiz, Xátiva, Spain.
To confirm the efficacy of a risk-adapted treatment approach for patients with clinical stage I seminoma. The aim was to reduce both the risk of relapse and the proportion of patients receiving adjuvant chemotherapy while maintaining a high cure rate.
From 2004 to 2008, 227 patients were included after orchiectomy in a multicenter study. Eighty-four patients (37%) presented no local risk factors, 44 patients (19%) had tumors larger than 4 cm, 25 patients (11%) had rete testis involvement, and 74 patients (33%) had both criteria. Only the latter group received two courses of adjuvant carboplatin, whereas the rest were managed by surveillance.
After a median follow-up time of 34 months, 16 relapses (7%) have been documented (15 [9.8%] among patients on surveillance and one [1.4%] among those treated with carboplatin). All relapses occurred in retroperitoneal lymph nodes, except for one case in pelvic nodes. Median node size was 25 mm, and median time to recurrence was 14 months. All patients were rendered disease-free with chemotherapy. The actuarial 3-year disease-free survival rate was 88.1% (95% CI, 82.3% to 93.9%) for patients on surveillance and 98.0% (95% CI, 94.0% to 100%) for those treated with adjuvant chemotherapy. Overall 3-year survival was 100%.
With the limitations of the short follow-up duration, we confirm that a risk-adapted approach is effective for stage I seminoma. Adjuvant carboplatin seems adequate treatment for patients with 2 risk criteria, as is active surveillance for those with 0 to one risk factors. More reliable predictive factors are needed to improve the applicability of this model.
Written by:
Aparicio J, Maroto P, García Del Muro X, Gumà J, Sánchez-Muñoz A, Margelí M, Doménech M, Bastús R, Fernández A, López-Brea M, Terrassa J, Meana A, Martínez Del Prado P, Sastre J, Satrústegui JJ, Gironés R, Robert L, Germà JR. Are you the author?
Reference: J Clin Oncol. 2011 Oct 31. Epub ahead of print.
doi: 10.1200/JCO.2011.36.0503
PubMed Abstract
PMID: 22042940
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