TY - JOUR
T1 - Risk-adapted treatment in clinical stage I testicular seminoma
T2 - the third Spanish Germ Cell Cancer Group study
AU - Aparicio, Jorge
AU - Maroto, Pablo
AU - del Muro, Xavier García
AU - Gumà, Josep
AU - Sánchez-Muñoz, Alfonso
AU - Margelí, Mireia
AU - Doménech, Montserrat
AU - Bastús, Romá
AU - Fernández, Antonio
AU - López-Brea, Marta
AU - Terrassa, Josefa
AU - Meana, Andrés
AU - del Prado, Purificación Martínez
AU - Sastre, Javier
AU - Satrústegui, Juan J
AU - Gironés, Regina
AU - Robert, Lidia
AU - Germà, José R
PY - 2011/12/10
Y1 - 2011/12/10
N2 - PURPOSE: 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.PATIENTS AND METHODS: 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.RESULTS: 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%.CONCLUSION: 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.
AB - PURPOSE: 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.PATIENTS AND METHODS: 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.RESULTS: 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%.CONCLUSION: 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.
KW - Adult
KW - Antineoplastic Agents/therapeutic use
KW - Carboplatin/therapeutic use
KW - Chemotherapy, Adjuvant
KW - Humans
KW - Male
KW - Middle Aged
KW - Neoplasms, Germ Cell and Embryonal/drug therapy
KW - Orchiectomy
KW - Prospective Studies
KW - Risk Factors
KW - Seminoma/drug therapy
KW - Testicular Neoplasms/drug therapy
KW - Young Adult
U2 - 10.1200/JCO.2011.36.0503
DO - 10.1200/JCO.2011.36.0503
M3 - Article
C2 - 22042940
SN - 0732-183X
VL - 29
SP - 4677
EP - 4681
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 35
ER -
