Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma.
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.


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.
Aparicio
J
J
Hospital Universitario La Fe, Valencia, Spain. aparicio_josurt@gva.es
García del Muro
X
X
Maroto
P
P
Paz-Ares
L
L
Alba
E
E
Sáenz
A
A
Terrasa
J
J
Barnadas
A
A
Almenar
D
D
Arranz
J A
JA
Sánchez
M
M
Fernández
A
A
Sastre
J
J
Carles
J
J
Dorca
J
J
Gumà
J
J
Yuste
A L
AL
Germà
J R
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery; D009367:Neoplasm Staging; D009919:Orchiectomy; D011050:Policy Making; D011159:Population Surveillance; D011182:Postoperative Care; D011446:Prospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000628:therapy*; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000628:therapy*
D000970:Antineoplastic Agents; D016190:Carboplatin