Abstract
PurposeClinical stage 1 (CS1) testicular seminoma involves an almost 100 % disease-specific survival in controlled clinical trials. We aimed to find out whether these results can be matched in patients managed on the routine care level.Patients, methodsIn total, 725 patients with seminoma CS1 were prospectively enrolled from 130 institutions. Adjuvant management as decided by local physicians involved surveillance (n = 256), radiotherapy (41), 1× Carboplatin (362), and 2× Carboplatin (66). We registered type of management, age, duration of follow-up (F/U), relapse, rete testis invasion (RTI), and tumor size. Actuarial relapse-free survival curves were calculated for treatment modalities and stratified for tumor sizes and RTI. A Cox regression model was calculated to explore for factors influencing relapses.ResultsDisease-specific survival was 100 %. Crude relapse rates were 8.2, 2.4, 5.0, and 1.5 % for surveillance, radiotherapy, 1× Carboplatin, and 2× Carboplatin after a median F/U of 30 months. RTI and tumor size were not associated with progression in surveillance patients. One course Carboplatin caused relapses in 6.8 % in tumor sizes >4 cm and 9.3 % (actuarial 13 %) in sizes >5 cm. The Cox model revealed the association of tumor size with recurrence in the entire seminoma population (Hazard ratio 1.17; 95 % confidence intervals 1.03–1.33).ConclusionsThe overall outcome of CS1 seminoma managed on the routine care level mirrors that of controlled trials. Unexpectedly, the risk factors in surveillance patients were not confirmed, but tumor size proved to be a risk indicator in the entire group of seminoma. Importantly, one course Carboplatin involved low efficacy to control the disease in large tumors.Electronic supplementary materialThe online version of this article (doi:10.1007/s00432-016-2162-z) contains supplementary material, which is available to authorized users.
Highlights
Clinical stage 1 (CS1) seminoma represents the most frequent way of presentation of testicular germ cell tumors (GCTs) (Sokoloff et al 2007; Heinzelbecker et al 2011)
The majority of relapses developed within the first 2 years after primary treatment, but additional events occurred during the later course with the latest arising after 60 months in the surveillance group
This study yielded five main results: (1) the overall treatment results of seminoma CS1 are excellent on the level of clinical routine practice, (2) surveillance strategies can be used successfully in this setting, (3) rete testis invasion and tumor size failed as indicators for progression in surveillance patients, (4) the one course Carboplatin regimen is less effective than expected, and (5) tumor size is predictive of relapse in patients receiving one course Carboplatin
Summary
Clinical stage 1 (CS1) seminoma represents the most frequent way of presentation of testicular germ cell tumors (GCTs) (Sokoloff et al 2007; Heinzelbecker et al 2011). A third alternative is the risk-adapted strategy with adjuvant Carboplatin therapy in the presence of risk factors and watchful waiting in the absence of these factors (Aparicio et al 2014; Beyer et al 2013). In this setting, a tumor size of greater than 4 cm and the invasion of seminoma cells into the rete testis represent recognized indicators for progression (Warde et al 2002). A tumor size of greater than 4 cm and the invasion of seminoma cells into the rete testis represent recognized indicators for progression (Warde et al 2002) These factors have been a matter of concern ever since their introduction into clinical practice. Only three evaluations have supported the safety of the single shot treatment to date (Tandstad et al 2011; Chau et al 2015; Diminutto et al 2015)
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