Abstract
4531 Background: From 2000-2007, 1,380 Norwegian and Swedish patients (pts) with seminomatous germ cell testicular cancer (SGCT) were followed prospectively according to a nationwide community-based treatment protocol, SWENOTECA V. The main objectives were to register all pts within the multicenter setting of the SWENOTECA in order to maintain and possibly improve the good results in the treatment of SGCT. Methods: Staging procedures, treatment and follow-up were standardized according to the protocol. Based upon physician and patient's preference treatment of clinical stage (CS) I pts were between surveillance (n=508) and 25.2 Gy radiotherapy (n=478) given to a para-aortic and ipsilateral iliac field. As data on adjuvant chemotherapy emerged, pts were also offered one course of adjuvant carboplatin (AUC7) (n=185). In clinical stage IIA, recommended treatment was radiotherapy to a total dose of 27.0 Gy. For clinical stages IIB-IV, cisplatinbased chemotherapy in the form of EP × 4 was recommended. However, in highly advanced seminoma initial BEP chemotherapy was recommended. Results: Of all pts 86% were in CS I, 10.7% in CS II, 1.8% in CS III and 1.4% in CS IV. Median follow-up was 4.7 years, IQR 3.2-6.4. OS survival was 97.6% (26 deaths). CSS was 99.6% (6 deaths) with only one death in primary CS I. In CS I surveillance yielded a relapse rate of 15.3%, adjuvant radiotherapy 0.9% and adjuvant Carboplatin 4.2%. In clinical stage IIA, 10.9% (3/29) relapsed after radiotherapy. In comparison no (0/67) CS IIB pts relapsed after chemotherapy. There were no deaths in CS IIA-B. Conclusions: Anationwide community-based treatment protocol for SGCT is feasible with excellent results. Surveillance is a good option for CS I pts. Despite a low relapse rate, adjuvant radiotherapy has now been abandoned in SWENOTECA as a recommended treatment option due to concerns of induction of secondary cancers. Adjuvant carboplatin (AUC7) in CS I will reduce the rate of relapse by about 70% compared to surveillance. The high rate of relapse in CS IIA pts treated with radiotherapy is of concern, especially when compared to the low number of relapses in CS IIB pts treated with chemotherapy (p=0.011). No significant financial relationships to disclose.
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