title: Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System.
abstract: The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown.
  
  
  
  A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis.
  
  
  
  The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P < .001 for 2006-2011 vs. 2001-2005; relative rate ratio, 19.3; 95% confidence interval [CI], 8.04-46.13). A later year of diagnosis was not significantly associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively.
  
  
  
  The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population.
authors.affiliation: Department of Urology, Madigan Army Medical Center, Tacoma, WA. Electronic address: jonathan.t.wingate.mil@mail.mil.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Wingate
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.affiliation: Department of Radiation Oncology, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Dusten M
authors.initials: DM
authors.lastname: Macdonald
authors.affiliation: Department of Urology, Madigan Army Medical Center, Tacoma, WA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Brand
mesh_terms: D016208:Databases, Factual; D004358:Drug Therapy / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D018239:Seminoma / Q000208:ethnology / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000208:ethnology / Q000473:pathology / Q000628:therapy*; D014481:United States / Q000208:ethnology
keywords: Adjuvant therapy; Chemotherapy; Radiotherapy; Surveillance; Testicular cancer