title: Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group.
abstract: OBJECTIVE
  A binational, population-based treatment protocol was established to prospectively treat and follow patients with seminomatous testicular cancer. The aim was to standardize care for all patients with seminoma to further improve the good results expected for this disease.
  
  
  METHODS
  From 2000 to 2006, a total of 1,384 Norwegian and Swedish patients were included in the study. Treatment in clinical stage 1 (CS1) was surveillance, adjuvant radiotherapy, or adjuvant carboplatin. In metastatic disease, recommended treatment was radiotherapy in CS2A and cisplatin-based chemotherapy in CS2B or higher.
  
  
  RESULTS
  At a median follow-up of 5.2 years, 5-year cause-specific survival was 99.6%. In CS1, 14.3% (65 of 512) of patients relapsed following surveillance, 3.9% (seven of 188) after carboplatin, and 0.8% (four of 481) after radiotherapy. We could not identify any factors predicting relapse in CS1 patients who were subjected to surveillance only. In CS2A, 10.9% (three of 29) patients relapsed after radiotherapy compared with no relapses in CS2A/B patients (zero of 73) treated with chemotherapy (P = .011).
  
  
  CONCLUSIONS
  An international, population-based treatment protocol for testicular seminoma is feasible with excellent results. Surveillance remains a good option for CS1 patients. No factors predicted relapse in CS1 patients on surveillance. Despite resulting in a lower rate of relapse than with adjuvant carboplatin, adjuvant radiotherapy has been abandoned in the Swedish and Norwegian Testicular Cancer Project (SWENOTECA) as a recommended treatment option because of concerns of induction of secondary cancers. The higher number of relapses in radiotherapy-treated CS2A patients when compared with chemotherapy-treated CS2A/B patients is of concern. Late toxicity of cisplatin-based chemotherapy versus radiotherapy must be considered in CS2A patients.
authors.affiliation: Department of Oncology, St. Olavs University Hospital, Post Box 3250 Sluppen, 7006 Trondheim, Norway. torgrim.tandstad@stolav.no
authors.forename: Torgrim
authors.initials: T
authors.lastname: Tandstad
authors.forename: Rune
authors.initials: R
authors.lastname: Smaaland
authors.forename: Arne
authors.initials: A
authors.lastname: Solberg
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.forename: Carl W
authors.initials: CW
authors.lastname: Langberg
authors.forename: Anna
authors.initials: A
authors.lastname: Laurell
authors.forename: Ulrika K
authors.initials: UK
authors.lastname: Stierner
authors.forename: Olof
authors.initials: O
authors.lastname: Ståhl
authors.forename: Eva K
authors.initials: EK
authors.lastname: Cavallin-Ståhl
authors.forename: Olbjørn H
authors.initials: OH
authors.lastname: Klepp
authors.forename: Olav
authors.initials: O
authors.lastname: Dahl
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cohn-Cedermark
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant / Q000592:standards*; D002945:Cisplatin / Q000008:administration & dosage; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D009664:Norway; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000592:standards*; D018239:Seminoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D013548:Sweden; D013736:Testicular Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D057832:Watchful Waiting / Q000592:standards
chemical_list: D016190:Carboplatin; D002945:Cisplatin