Abstract | BACKGROUND: After decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting. PATIENTS AND METHODS: From 1994 to 1999, 203 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance. RESULTS: Median follow-up was 52 months (range 14-92). Relapses were observed in two (3.3%) patients treated with carboplatin and in 23 patients (16.1%) on surveillance, with a median time to recurrence of 11 months (range 3.9-39.6). All relapsing patients were rendered disease-free, mainly with cisplatin-based chemotherapy. Four patients died from tumor-unrelated causes. Actuarial 5-year overall survival was 96.7% and cause-specific survival was 100%. Five-year disease-free survival was 83.5% for patients on surveillance, and 96.6% for those receiving carboplatin. CONCLUSIONS: This dual treatment policy is feasible in a multicenter setting and preserves 70% of patients from adjuvant chemotherapy. Single-agent carboplatin is effective in reducing the relapse rate in patients with high-risk stage I seminoma. A better definition of local risk features would probably improve patient selection, thus minimizing the incidence of recurrences on surveillance.
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Authors | J Aparicio, X García del Muro, P Maroto, L Paz-Ares, E Alba, A Sáenz, J Terrasa, A Barnadas, D Almenar, J A Arranz, M Sánchez, A Fernández, J Sastre, J Carles, J Dorca, J Gumà, A L Yuste, J R Germà, Spanish Germ Cell Cancer Cooperative Group (GG) |
Journal | Annals of oncology : official journal of the European Society for Medical Oncology
(Ann Oncol)
Vol. 14
Issue 6
Pg. 867-72
(Jun 2003)
ISSN: 0923-7534 [Print] England |
PMID | 12796024
(Publication Type: Journal Article, Multicenter Study)
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Chemical References |
- Antineoplastic Agents
- Carboplatin
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents
(therapeutic use)
- Carboplatin
(therapeutic use)
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Disease-Free Survival
- Humans
- Male
- Middle Aged
- Neoplasm Recurrence, Local
(drug therapy, surgery)
- Neoplasm Staging
- Orchiectomy
- Policy Making
- Population Surveillance
- Postoperative Care
- Prospective Studies
- Risk Factors
- Seminoma
(therapy)
- Survival Rate
- Testicular Neoplasms
(therapy)
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