Management options for stage I seminoma.
Stage I seminoma is the most common clinical scenario among patients with testicular cancer. Following orchiectomy, various treatment alternatives (adjuvant radiotherapy, surveillance, chemotherapy) can be offered that yield similar efficacy results and definitive cure is the rule. However, there is no consensus on the optimal management choice and considerable debate has been raised in recent years. The pros and the cons associated with each therapy, as well as their long-term outcomes are discussed in this review. Overall burden of treatment needed, therapy-related morbidity, economic costs, quality of life issues and patient preferences should all be considered. Refinement in the knowledge of predictive factors for relapse and mounting experience with both surveillance and adjuvant chemotherapy have led to consideration of risk-adapted treatment strategies as an alternative to standard radiotherapy. Although this model needs to be improved and validated, active close surveillance for low-risk patients and adjuvant therapy for those uncompliant or at higher risk of relapse seem to be acceptable options for patients with stage I seminoma.
Aparicio
Jorge
J
Hospital Universitario La Fe, Avda Campanar 21, E-46009 Valencia, Spain. japariciou@seom.org
Díaz
Roberto
R
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009367:Neoplasm Staging; D009919:Orchiectomy; D011379:Prognosis; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012306:Risk; D018239:Seminoma / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*
D000970:Antineoplastic Agents; D018906:Antineoplastic Agents, Alkylating; D016190:Carboplatin