title: Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma.
abstract: BACKGROUND
  Extended field radiotherapy is a standard of care for low volume stage II testicular seminoma. We hypothesized that neoadjuvant carboplatin might reduce the recurrence risk.
  
  
  METHODS
  In a single-arm study, 51 patients were treated between May 1996 and November 2011 with a single cycle of carboplatin followed by radiotherapy. The radiation field was reduced from an extended abdomino-pelvic field to just the para-aortic region, and the radiation dose from 35 Gy to 30 Gy in 39 patients.
  
  
  RESULTS
  After a median follow-up of 55 months (range 8-151 months) with 38 (74%) of the patients having been followed for >2 years, there have been no relapses (95% confidence limits of 5-year relapse-free survival of 93%-100%). Toxicity has been low with grade 3 toxicity limited to four patients with grade 3 haematological toxicity (with no clinical sequelae) and one patient with grade 3 nausea (during radiotherapy). No patients experienced grade 4 toxicity.
  
  
  CONCLUSIONS
  The results of this pilot study suggest that a single cycle of neoadjuvant carboplatin before radiotherapy may reduce recurrence risk compared with radiotherapy alone and permit a smaller radiation field, and this approach is proposed for further investigation.
authors.affiliation: Division of Radiotherapy & Imaging, The Institute of Cancer Research and Urological Oncology Unit, The Royal Marsden NHS Trust, Sutton, UK. alan.horwich@icr.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.forename: D P
authors.initials: DP
authors.lastname: Dearnaley
authors.forename: A
authors.initials: A
authors.lastname: Sohaib
authors.forename: K
authors.initials: K
authors.lastname: Pennert
authors.forename: R A
authors.initials: RA
authors.lastname: Huddart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016190:Carboplatin / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000517:prevention & control / Q000532:radiotherapy; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018239:Seminoma / Q000188:drug therapy* / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin
keywords: carboplatin; germ cell tumour; radiotherapy; seminoma