859P - Management of Post Orchidectomy Stage I Classical Seminoma: 11 Year Outcome Data of a UK Regional Cancer Unit

Abstract

ABSTRACT Introduction Stage I classical seminoma has a 95% 5yr OS. Post-orchidectomy treatment options include para-aortic radiotherapy, single agent carboplatin or active surveillance. This retrospective study reviewed changing practice and outcomes over a 11 year period in a regional cancer unit. Patients and methods 188 consecutive patients seen from January 2000 to December 2010 were identified. Initial risk factors, treatment received and post treatment response were recorded and relapse free and overall survival calculated Results Adjuvant radiotherapy was given to 106 patients (56.4%), adjuvant chemotherapy to 56 (29.8%) and active surveillance to 26 (13.8%). Five year RFS by group was 97.2%, 89.9% and 76.9%. Fifteen patients relapsed with one dying despite third line treatment. Overall CSS was 99.4%. In the period before 2005 tumour size and rete testis invasion was documented in 9% of patients and active surveillance offered to none. After this time the two risk factors were documented in 82% and surveillance offered to 19.5%. Management and outcome stratified by presence of risk factor. Management Risk factor Surveillance Adjuvant Chemotherapy Adjuvant XRT Relapse rate None (51 patients) 47.1% 25.6% 27.4% 7.5% One (24) 22.0% 42.0% 36.0% 14.0% Two (12) 0% 58.3% 41.7% 12.5% Conclusion This review's outcomes broadly correspond with published data although with increased incidence of relapse following standard adjuvant chemotherapy- presumably an artifact of small numbers. Adjuvant treatment increases 5yr RFS compared to active surveillance but excellent CSS is achieved after either. The vast majority of radiotherapy (85%)was offered in the first two thirds of the study period and reflects older practice. The absence of risk factors appears to reduce the rate of relapse and should guide treatment decisions. The increasing awareness of the importance of assessing risk factors when deciding on treatment is reflected in their improved identification in later patients and the increasing use of a surveillance strategy in those at lower risk of relapse. Disclosure All authors have declared no conflicts of interest.