title: Clinical Characteristics and Outcomes of Late Relapse in Stage I Testicular Seminoma.
abstract: To identify the characteristics and outcomes associated with late relapse in stage I seminoma.
  
  
  
  A retrospective review was carried out of all patients with stage I seminoma managed at our institution between 1981 and 2011. Data were obtained from a prospectively maintained database. Late relapse was defined as tumour recurrence > 2 years after orchiectomy.
  
  
  
  Overall, 1060 stage I seminoma patients were managed with active surveillance (n=766) or adjuvant radiotherapy (n=294). At a median follow-up of 10.6 years (range 1.2-30), 142 patients relapsed at a median (range) of 14 (3-129) months; 128 on active surveillance and 14 after adjuvant radiotherapy. The late relapse rate for the active surveillance and adjuvant radiotherapy groups was 4% and 1%, respectively. There was no specific clinicopathological factor associated with late relapse. Isolated para-aortic node(s) was the most common relapse site in active surveillance patients either in late (88%) or early relapse (82%). Among the active surveillance group, no patients with late relapse subsequently developed a second relapse after either salvage radiotherapy (n=25) or chemotherapy (n=6), whereas in early relapse patients a second relapse was reported in seven (10%) of 72 patients treated with salvage radiotherapy and one (4%) of 23 patients who received chemotherapy; all second relapses were subsequently salvaged with chemotherapy. No patient in the adjuvant radiotherapy group developed a second relapse after salvage chemotherapy (n=10) or inguinal radiotherapy/surgery (n=4). Of seven deaths, only one was related to seminoma. Among active surveillance patients, the 10 year overall survival for late and early relapse groups were 100% and 96% (P = 0.2), whereas the 10 year cancer-specific survival rates were 100% and 99% (P = 0.3), respectively.
  
  
  
  In stage I seminoma, the extent and pattern of late relapse is similar to that for early relapse. For active surveillance patients, selective use of salvage radiotherapy/chemotherapy for relapse results in excellent outcomes regardless of the timing of relapse, whereas salvage radiotherapy for late relapse seems to be associated with a minimal risk of second relapse.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Hosni
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Warde
authors.affiliation: Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Jewett
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Bedard
authors.affiliation: Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Hamilton
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Moore
authors.affiliation: Department of Surgical Oncology (Urology), Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Nayan
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Huang
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: E G
authors.initials: EG
authors.lastname: Atenafu
authors.affiliation: Department of Medical Imaging, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: O'Malley
authors.affiliation: Department of Pathology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Sweet
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada. Electronic address: Peter.Chung@rmp.uhn.on.ca.
authors.forename: P
authors.initials: P
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016208:Databases, Factual; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D009919:Orchiectomy / Q000379:methods*; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012189:Retrospective Studies; D016879:Salvage Therapy; D018239:Seminoma / Q000473:pathology* / Q000628:therapy; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000473:pathology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Late relapse; outcome; radiation; seminoma; surveillance; testicular