title: Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish Germ Cell Cancer Group study.
abstract: OBJECTIVE
  To confirm the efficacy of a risk-adapted treatment approach for patients with clinical stage I seminoma. The aim was to reduce both the risk of relapse and the proportion of patients receiving adjuvant chemotherapy while maintaining a high cure rate.
  
  
  METHODS
  From 2004 to 2008, 227 patients were included after orchiectomy in a multicenter study. Eighty-four patients (37%) presented no local risk factors, 44 patients (19%) had tumors larger than 4 cm, 25 patients (11%) had rete testis involvement, and 74 patients (33%) had both criteria. Only the latter group received two courses of adjuvant carboplatin, whereas the rest were managed by surveillance.
  
  
  RESULTS
  After a median follow-up time of 34 months, 16 relapses (7%) have been documented (15 [9.8%] among patients on surveillance and one [1.4%] among those treated with carboplatin). All relapses occurred in retroperitoneal lymph nodes, except for one case in pelvic nodes. Median node size was 25 mm, and median time to recurrence was 14 months. All patients were rendered disease-free with chemotherapy. The actuarial 3-year disease-free survival rate was 88.1% (95% CI, 82.3% to 93.9%) for patients on surveillance and 98.0% (95% CI, 94.0% to 100%) for those treated with adjuvant chemotherapy. Overall 3-year survival was 100%.
  
  
  CONCLUSIONS
  With the limitations of the short follow-up duration, we confirm that a risk-adapted approach is effective for stage I seminoma. Adjuvant carboplatin seems adequate treatment for patients with 2 risk criteria, as is active surveillance for those with 0 to one risk factors. More reliable predictive factors are needed to improve the applicability of this model.
authors: Hospital Universitario y Politécnico La Fe, Valencia, Spain. japariciou@seom.org
authors: Jorge
authors: J
authors: Aparicio
authors: Pablo
authors: P
authors: Maroto
authors: Xavier García
authors: XG
authors: del Muro
authors: Josep
authors: J
authors: Gumà
authors: Alfonso
authors: A
authors: Sánchez-Muñoz
authors: Mireia
authors: M
authors: Margelí
authors: Montserrat
authors: M
authors: Doménech
authors: Romá
authors: R
authors: Bastús
authors: Antonio
authors: A
authors: Fernández
authors: Marta
authors: M
authors: López-Brea
authors: Josefa
authors: J
authors: Terrassa
authors: Andrés
authors: A
authors: Meana
authors: Purificación Martínez
authors: PM
authors: del Prado
authors: Javier
authors: J
authors: Sastre
authors: Juan J
authors: JJ
authors: Satrústegui
authors: Regina
authors: R
authors: Gironés
authors: Lidia
authors: L
authors: Robert
authors: José R
authors: JR
authors: Germà
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; 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; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin