Results of a policy of surveillance in stage I testicular seminoma

Abstract

Purpose : To determine what proportion of patients with Stage I testicular seminoma will be cured with orchidectomy alone. Methods and Materials : From August 1984 to December 1991 148 patients with Stage I testicular seminoma were entered on a prospective study of surveillance following orchidectomy. The eligibility criteria included a normal chest X ray, lymphogram, computed tomography (CT) of the abdomen and pelvis, and normal post-orchidectomy tumor markers (AFP and BHCG). Patients were followed with a clinical assessment (markers, chest X ray and CT abdomen and pelvis) at 4 to 6 monthly intervals. Results : With a median follow-up of 47 months (range 7–87 months), the actuarial relapse-free rate was 81% at 5 years. Twenty-three patients have relapsed with a median time to relapse of 15 months (range 2–61 months). Four patients (17%) relapsed at 4 or more years from diagnosis. Twenty-one of the 23 relapse occurred in the paraaortic lymph nodes, one patient relapsed in the mediastinum and ipsilateral inguinal nodes and one patient had an isolated ipsilateral inguinal node relapse. Nineteen patients were treated for relapse with external beam radiation therapy of which three developed a second relpase and were salvaged with chemotherapy. Four patients were treated for first relapse with chemotherapy and one developed a second with chemotherapy. Four patients diagnosis was the only prognostic factor for relapse, with patients age ≤ 34 having an actuarial relapse-free rate at 5 years of 70% in contrast to a 91% relapse-free rate in those > 34 years of age. Conclusion : We recommend that surveillance in Stage I testicular seminoma should only be performed in a study setting until further data regarding the risk of late relapse and the efficacy of salvage chemotherapy is available.