title: Adjuvant Carboplatin Treatment in 115 Patients With Stage I Seminoma: Retrospective Multicenter Survey.
abstract: BACKGROUND
  The administration of carboplatin AUC 7 has become a standard adjuvant option for patients undergoing orchiectomy for stage I seminoma, in alternative to radiotherapy on retroperitoneal lymphnodes or surveillance. The toxicity of AUC 7 carboplatin appeared manageable in the pivotal trial of Oliver et al, but dose ranges were not reported. Fear of toxicity may induce arbitrary dose reductions, which may potentially compromise patients' outcome.
  
  
  METHODS
  We reviewed adjuvant carboplatin administration in 115 stage I seminoma patients followed in 11 Italian medical oncology centers since 2005. Clinical and pathological data, modality of carboplatin dose calculation, dose reductions, toxicities, and relapses were recorded.
  
  
  RESULTS
  Median age was 35 years (range, 18-65 years), adverse prognostic factors were either T ≥ 4 cm (17.4%) or rete testis invasion (28.7%), both of them (35.7%), none or unspecified (18.3%). GFR was estimated mainly by Cockroft-Gault formula (55.7%) or Jeliffe formula (26.1%), with a median of 105 mL/min (range, 75-209 mL/min). The median dose of carboplatin was 900 mg (range, 690-1535 mg). A dose reduction > 10% was applied to 14 patients. Toxicities were mild fatigue, moderate nausea/vomiting, 5.2% of grade 3 to 4 thrombocytopenia. After a median follow-up of 22.1 months, 5.2% of patients have relapsed in the retroperitoneal lymph nodes. None of the patients that relapsed were treated with reduced dose. All but one achieved complete remission with salvage chemotherapy.
  
  
  CONCLUSIONS
  Adjuvant AUC 7 carboplatin reduce relapses of stage I seminoma patients to 5.2%, with manageable toxicities. Dose reductions should be proscribed.
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Diminutto
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy. Electronic address: umberto.basso@ioveneto.it.
authors.forename: Umberto
authors.initials: U
authors.lastname: Basso
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Maruzzo
authors.affiliation: Casa Sollievo della Sofferenza IRCCS, Medical Oncology Department, Foggia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Morelli
authors.affiliation: IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Medical Oncology Department, Forlì-Cesena, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: De Giorgi
authors.affiliation: Azienda ULSS 4 Alto Vicentino, Medical Oncology Department, Vicenza, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Perin
authors.affiliation: Casa di Cura Polispecialistica Dott. Pederzoli, Medical Oncology Department, Verona, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Fraccon
authors.affiliation: Ospedale Santa Maria Degli Angeli, Medical Oncology Department, Pordenone, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lo Re
authors.affiliation: Fondazione Poliambulanza - Istituto Ospedaliero, Medical Oncology Department, Brescia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Rizzi
authors.affiliation: Azienda Ospedaliera Universitaria Integrata Verona, Medical Oncology Department, Verona, Italy.
authors.forename: Teodoro
authors.initials: T
authors.lastname: Sava
authors.affiliation: IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Medical Oncology Department, Genova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fornarini
authors.affiliation: Spedali Civili di Brescia, Medical Oncology Department, Brescia, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Valcamonico
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy.
authors.forename: Fable
authors.initials: F
authors.lastname: Zustovich
authors.affiliation: Azienda Ospedaliera Universitaria Integrata Verona, Medical Oncology Department, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Massari
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Zanardi
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Roma
authors.affiliation: Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italy.
authors.forename: Filiberto
authors.initials: F
authors.lastname: Zattoni
authors.affiliation: Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy.
authors.forename: Vittorina
authors.initials: V
authors.lastname: Zagonel
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage* / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018239:Seminoma / Q000188:drug therapy* / Q000473:pathology; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D016190:Carboplatin
keywords: Chemotherapy; Dose reduction; Glomerular Filtration Rate (GFR); Relapse; Toxicity