Original Papers - Oncology Open access

Surveillance as a safe and effective option for treatment of stage I seminoma

Authors

Published
5 September 2023
Section
Original Papers - Oncology
DOI
10.4081/aiua.2023.11513

Abstract

Introdubction: Stage I seminoma has a very good prognosis, yet approximately 15% have subclinical metastatic disease and will relapse after orchidectomy alone. Several management approaches have been investigated. We aimed to evaluate the clinical outcomes of real-world patients with stage I seminoma, analysing prognostic factors influencing treatment choice and oncological outcomes. Methods: Retrospective, single institution study, with 55 patients diagnosed with clinical stage I seminoma between 2007 and 2020. Selected patients were analysed regarding three management approaches - surveillance, adjuvant radiotherapy and adjuvant carboplatin AUC7. Overall survival and progression-free survival outcomes were analysed. Predictors of treatment choice were determined, and predictors of recurrence were analysed in patients on active surveillance. Results: The median follow-up time was 91 months (13-165). Overall survival at 10 years was 98.2%. Stage I seminoma patients had a 1-, 3- and 10-year progression free survival of 98%, 94% and 89%, respectively. Three-year progression free survival was 92.0% for those on active surveillance (IC95%, 91.5-92.5%), 95.2% for carboplatin (IC95%, 94.8-95.6%) and 100% for those on adjuvant radiotherapy (p > 0.05). All relapses on active surveillance protocols occurred during the first 24 months. Overall, 43% of patients who underwent adjuvant treatment reported adverse effects of therapy, with higher incidence on radiotherapy group (63%). Conclusions: Stage I seminoma have excellent prognosis, high cure rates, and low treatment-associated morbidity. Active surveillance is a safe modality when applied to selected patients. Adjuvant radiotherapy and adjuvant chemotherapy with carboplatin show similar results, with fewer adverse effects on chemotherapy arm.

Keywords

References

  1. Park JS, Kim J, Elghiaty A, Ham WS. Recent global trends in testicular cancer incidence and mortality. Medicine. 2018; 97:e12390 DOI: https://doi.org/10.1097/MD.0000000000012390
  2. Powles TB, Bhardwa J, Shamash J, et al. The changing presentation of germ cell tumours of the testis between 1983 and 2002. BJU Int 2005; 95:1197-1200. DOI: https://doi.org/10.1111/j.1464-410X.2005.05504.x
  3. Boormans JL, Mayor de Castro J, Marconi L, et al. Testicular Tumour Size and Rete Testis Invasion as Prognostic Factors for the Risk of Relapse of Clinical Stage I Seminoma Testis Patients Under Surveillance: a Systematic Review by the Testicular Cancer Guidelines Panel. Eur Urol. 2018; 73:394-405. DOI: https://doi.org/10.1016/j.eururo.2017.09.025
  4. Kollmannsberger C, Tandstad T, Bedard PL, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015; 33:51-57. DOI: https://doi.org/10.1200/JCO.2014.56.2116
  5. Groll RJ, Warde P, Jewett MAS. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol. 2007; 64:182-197. DOI: https://doi.org/10.1016/j.critrevonc.2007.04.014
  6. Warde PR, Gospodarowicz MK, Goodman PJ, et al. Results of a policy of surveillance in stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 1993; 27:11-15. DOI: https://doi.org/10.1016/0360-3016(93)90415-R
  7. Aparicio J, Maroto P, García del Muro X, et al. Prognostic factors for relapse in stage I seminoma: a new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG). Ann Oncol. 2014; 25:2173-2178.
  8. Aparicio J, Maroto P, García del Muro X, et al. Prognostic factors for relapse in stage I seminoma: A new nomogram derived from three consecutive, risk-adapted studies from the Spanish Germ Cell Cancer Group (SGCCG). Annals of Oncology. 2014; 25:2173-2178. DOI: https://doi.org/10.1093/annonc/mdu437
  9. Tandstad T, Ståhl O, Dahl O, et al. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, riskadapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol. 2016; 27:1299-1304. DOI: https://doi.org/10.1093/annonc/mdw164
  10. Oliver RTD, Mason MD, Mead GM, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005; 366:293-300. DOI: https://doi.org/10.1016/S0140-6736(05)66984-X
  11. Oliver RTD, Mead GM, Rustin GJS, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol 2011; 29:957-962. DOI: https://doi.org/10.1200/JCO.2009.26.4655
  12. Chung P, Mayhew LA, Warde P, et al. Management of stage I seminomatous testicular cancer: a systematic review. Clin Oncol. 2010; 22:6-16. DOI: https://doi.org/10.1016/j.clon.2009.08.006
  13. Fischer S, Tandstad T, Wheater M, et al. Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma. J Clin Oncol. 2017; 35:194-200. DOI: https://doi.org/10.1200/JCO.2016.69.0958
  14. Aparicio J, García del Muro X, Maroto P, et al. Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol. 2003; 14:867-872. DOI: https://doi.org/10.1093/annonc/mdg241
  15. Fosså SD, Horwich A, Russell JM, et al. Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. J Clin Oncol. 1999; 17:1146-1154. DOI: https://doi.org/10.1200/JCO.1999.17.4.1146
  16. Calvert AH, Newell DR, Gumbrell LA, et al. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol. 1989; 7:1748-1756. DOI: https://doi.org/10.1200/JCO.1989.7.11.1748
  17. Marques-Pinto A, Gomes AI, Febra J, et al. Specialist management of testicular cancer: Report of the last 10 years at a Portuguese tertiary referral academic centre. Arch Ital Urol Androl. 2021; 93:153-157. DOI: https://doi.org/10.4081/aiua.2021.2.153
  18. Zengerling F, Kunath F, Jensen K, et al. Prognostic factors for tumor recurrence in patients with clinical stage I seminoma undergoing surveillance—A systematic review. Urologic Oncology: Seminars and Original Investigations. 2018; 36:448-458. DOI: https://doi.org/10.1016/j.urolonc.2017.06.047
  19. Aparicio J, Maroto P, Muro XG del, et al. Risk-Adapted Treatment in Clinical Stage I Testicular Seminoma: The Third Spanish Germ Cell Cancer Group Study. J Clin Oncol. 2011; 29:4677-4681. DOI: https://doi.org/10.1200/JCO.2011.36.0503
  20. Sharda NN, Kinsella TJ, Ritter MA. Adjuvant radiation versus observation: a cost analysis of alternate management schemes in early-stage testicular seminoma. J Clin Oncol. 1996; 14:2933-2939. DOI: https://doi.org/10.1200/JCO.1996.14.11.2933
  21. Zagars GK, Babaian RJ. Stage I testicular seminoma: rationale for postorchiectomy radiation therapy. Int J Radiat Oncol Biol Phys. 1987; 13:155-162. DOI: https://doi.org/10.1016/0360-3016(87)90122-2
  22. Mahmoud Sayed M, Nasr AM, Saad Eldin IM, Abdelazim YA. Stage I seminoma: outcome of different treatment modalities and changes in patterns of care: A single institution experience. Arch Ital Urol Androl. 2023; 95:11057. DOI: https://doi.org/10.4081/aiua.2023.11057

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