Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study.
OBJECTIVE
To assess the efficacy of a risk-adapted treatment policy for patients with stage I seminoma by using universally accepted risk criteria.


METHODS
Between 1999 and 2003, 314 patients with clinical stage I seminoma after orchiectomy were prospectively included. One hundred patients (31.8%) presented no risk factors and were managed with surveillance. In contrast, 131 patients (41.7%) had tumors larger than 4 cm, 33 patients (10.5%) had rete testis involvement, and 50 patients (15.9%) had both risk factors. All the latter received two courses of adjuvant carboplatin.


RESULTS
Chemotherapy was well tolerated, as only 17 patients (7.9%) presented grade 3 to 4 toxicity. Relapses were observed in six patients (6.0%) on surveillance and in seven patients (3.3%) treated with carboplatin (0.8% of tumors larger than 4 cm, 9.1% of those involving the rete testis, and 6.0% of patients with both risk criteria). All were located at the retroperitoneum, except for one at the spermatic cord. Median tumor size was 25 mm (range, 11 to 70 mm), and median time to relapse was 9 months (range, 4 to 28 months). All patients were rendered disease-free with chemotherapy (etoposide plus cisplatin). Median follow-up was 34 months (range, 12 to 72 months). The actuarial 5-year disease-free survival rate was 93.4% for patients on surveillance and 96.2% for patients treated with adjuvant chemotherapy. Overall 5-year survival was 100%.


CONCLUSIONS
Adjuvant carboplatin is effective in reducing the relapse rate in patients with stage I seminoma and risk factors. A risk-adapted strategy is safe and feasible and should be considered an alternative to systematic approaches, such as irradiation, chemotherapy, or surveillance.
Aparicio
Jorge
J
Department of Medical Oncology, Hospital Universitario La Fe, Avda Campanar 21, E-46009 Valencia, Spain. japariciou@seom.org
Germà
José R
JR
García del Muro
Xavier
X
Maroto
Pablo
P
Arranz
José A
JA
Sáenz
Alberto
A
Barnadas
Agustín
A
Dorca
Joan
J
Gumà
Josep
J
Olmos
David
D
Bastús
Romá
R
Carles
Joan
J
Almenar
Daniel
D
Sánchez
Miguel
M
Paz-Ares
Luis
L
Satrústegui
Juan J
JJ
Mellado
Begoña
B
Balil
Ana
A
López-Brea
Marta
M
Sánchez
Alfredo
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D009503:Neutropenia / Q000139:chemically induced; D009919:Orchiectomy; D011446:Prospective Studies; D012307:Risk Factors; D018239:Seminoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D000970:Antineoplastic Agents; D018997:Chorionic Gonadotropin, beta Subunit, Human; D016190:Carboplatin