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Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy : A report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA)

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Author

  • Torgrim Tandstad
  • Olof Ståhl
  • O. Dahl
  • H. S. Haugnes
  • U. Håkansson
  • A. Karlsdottir
  • A. Kjellman
  • C. W. Langberg
  • A. Laurell
  • J. Oldenburg
  • A. Solberg
  • K. Söderström
  • U. Stierner
  • E. Cavallin-Ståhl
  • R. Wahlqvist
  • N. Wall
  • G. Cohn-Cedermark
Show all

Summary, in English

Background: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter >4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. Patients and methods: From 2007 to 2010, 897 patients were included in a prospective, population-based, riskadapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n=469) or surveillance (n=422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. Results: At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis [hazard ratio (HR) 1.9, P = 0.011] and tumor diameter >4 cm (HR 2.7, P <0.001) were identified as risk factors predicting relapse. In patients without risk factors, the relapse rate (RR) was 4.0% for patients managed by surveillance and 2.2% in patients receiving adjuvant carboplatin. In patients with one or two risk factors, the RR was 15.5% in patients managed by surveillance and 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin 4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.

Publishing year

2016-07-01

Language

English

Pages

1299-1304

Publication/Series

Annals of Oncology

Volume

27

Issue

7

Document type

Journal article

Publisher

Oxford University Press

Topic

  • Cancer and Oncology

Keywords

  • Adjuvant carboplatin
  • Prognostic factors
  • Risk-adapted
  • Seminoma
  • Surveillance
  • Testicular cancer

Status

Published

Research group

  • Urology

ISBN/ISSN/Other

  • ISSN: 0923-7534