What is the value of routine follow-up in stage I seminoma after paraaortic radiotherapy?: an analysis of the German Testicular Cancer Study Group (GTCSG) in 675 prospectively followed patients.
OBJECTIVE
Routine posttreatment surveillance is recommended after adjuvant radiotherapy for stage I seminoma. However, systematic studies on the value of follow-up in these patients are missing. This report addresses the efficiency of routine follow-up in stage I seminoma with particular reference to the mode of detection of relapse and the costs of posttreatment screening.


METHODS
All follow-up investigations of a prospectively followed cohort of 675 patients with stage I seminoma treated with PA radiotherapy were analyzed with respect to the first indications of relapse, patterns of recurrence, risk factors of relapse, and cost-efficiency of the different technical examinations of the follow-up schedule over a 10-year period.


RESULTS
With a median time to follow-up of 61 months, recurrence was diagnosed by symptoms or physical examination in 14 out of 26 relapsing patients. Among the technical follow-up investigations abdominopelvic imaging had the highest detection rate for relapse, while thoracic imaging and marker analysis were inefficient. Abdominal sonography had the highest cost-efficiency of all technical follow-up investigations, while computed tomography (CT) scans were responsible for approximately 60% of all costs. The authors failed to identify risk factors predictive of relapse after adjuvant irradiation.


CONCLUSIONS
Routine technical investigations during follow-up after PA radiotherapy for stage I seminoma yield only a low detection rate of relapse from cancer. The data presented here provide no evidence for the value of technical follow-up beyond the 3rd year after treatment or routine screening of the chest. Thorough physical examination of the patients should be encouraged. Patients should be informed about potential symptoms indicative of recurrence. Restrictive use of abdominopelvic CT scans will reduce exposure to ionizing radiation and considerably increase the cost-efficiency of follow-up.
Clasen
Johannes
J
Department of Radiation Oncology, Tübingen University, Germany. strahlenklinik@vincentius-ka.de
Schmidberger
Heinz
H
Souchon
Rainer
R
Weissbach
Lothar
L
Hartmann
Michael
M
Hartmann
Jörg T
JT
Hehr
Thomas
T
Bamberg
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D012307:Risk Factors; D018239:Seminoma / Q000175:diagnosis / Q000191:economics* / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000532:radiotherapy*