Controversies in the management of clinical stage I testicular seminoma.
BACKGROUND
Following orchiectomy patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (AS) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, mainly second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as adjuvant therapy for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches - AS versus adjuvant chemotherapy (ACT) on survival in patients with CSI testicular seminoma.


METHODS
The cross-sectional study analyzed a total of 106 patients collected at a single centre between 4/2008-8/2015, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches.


RESULTS
In group A (low-risk), consisting of 84 patients, who underwent AS, relapse occurred in 10 (11.9%) patients after a mean follow-up of 13.8 months. In group B (high-risk), consisting of 22 patients, who were treated with ACT, relapse occurred in two (9.1%) patients after a mean follow-up of 13.8 months. Overall survival of patients in both groups was 100% with a mean follow-up of 25.3 months. The statistically significant difference in progression-free survival (PFS) between these two groups was not found.


CONCLUSIONS
ACT seems to be adequate treatment for patients with high-risk of relapse, as well as AS for those with low-risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.
St. Elisabeth University of Health and Social Sciences, Bratislava, Slovak Republic; Cancer Research Institute, Slovak Academy of Sciences, Bratislava, Slovak Republic; Pharm-In, Ltd., Bratislava, Slovak Republic.
Martina
M
Ondrusova
Department of Nuclear Medicine, Comenius University, Faculty of Medicine & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic.
Sona
S
Balogova
2 Department of Radiology, Comenius University, Faculty of Medicine & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic.
Viera
V
Lehotska
Department of Pathology, Slovak Medical University & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic.
Karol
K
Kajo
Department of Medical Oncology & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic.
Bela
B
Mrinakova
1 Department of Oncology, Comenius University, Faculty of Medicine & St. Elisabeth Cancer Institute, Bratislava, Slovak Republic.
Dalibor
D
Ondrus
chemotherapy; relapse rate; seminoma; surveillance; testicular cancer