title: Long term outcome and cost in the management of stage I testicular seminoma.
abstract: OBJECTIVE
  To validate the use of surveillance as an alternative to adjuvant RT in clinical stage I seminoma, we analyzed our experience with the two approaches in terms of long term outcome and cost.
  
  
  METHODS
  Between January 1981 and December 1994, 471 patients with stage I testicular seminoma were treated at our institution. Of these, 245 patients received post-operative RT (25 Gy) to the retroperitoneal lymph nodes, and 226 have been managed with surveillance following orchidectomy. Two patients were included in this series twice; both had RT previously for seminoma, were placed on surveillance for a contralateral seminoma and were analyzed for outcome of both primary tumors. The costs associated with both approaches were estimated in 1994 Canadian dollars (C$).
  
  
  RESULTS
  With a median follow-up of 7.7 years in the surveillance patients, and 9.7 years in the adjuvant RT cohort, the 5 year actuarial survival for all patients was 97% and the cause-specific survival (CSS) was 99.8%. Of the 226 patients on surveillance 37 patients have relapsed to date; five of those developed a second relapse. One patient has died of disease. Of the 245 patients treated with adjuvant RT, 14 patients have relapsed and none had a second relapse. The CSS was 100%. Thirteen patients on surveillance (5.7%) and 10 patients treated with post-operative RT (4.1%) have received chemotherapy as part of their management. One hundred and eighty-nine patients on surveillance have received no post-orchidectomy treatment to date. Surveillance was more expensive with an average additional cost per patient per year of Can$2620 over 10 years.
  
  
  CONCLUSIONS
  Both adjuvant RT and surveillance give excellent results in stage I seminoma. The documented increased risk of second malignant tumors following RT must be taken into account when considering the additional cost of surveillance. The routine use of post-operative RT in stage I seminoma should be reconsidered and a surveillance program offered to all patients as an alternative management option.
authors: Department of Radiation Oncology, University of Toronto, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
authors: P
authors: P
authors: Warde
authors: M K
authors: MK
authors: Gospodarowicz
authors: T
authors: T
authors: Panzarella
authors: E
authors: E
authors: Chow
authors: T
authors: T
authors: Murphy
authors: C N
authors: CN
authors: Catton
authors: J F
authors: JF
authors: Sturgeon
authors: M
authors: M
authors: Moore
authors: M
authors: M
authors: Milosevic
authors: M A
authors: MA
authors: Jewett
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018239:Seminoma / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D013736:Testicular Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome