Stage IIA and IIB testicular seminoma treated post-orchiectomy with radiation therapy versus other approaches: a population-based analysis of 241 patients

Abstract

Objectives To evaluate post-orchiectomy utilization of radiation therapy (RT) versus other management approaches in stage IIA and IIB testicular seminoma patients.Materials and Methods Two hundred and forty-one patients with stage IIA and IIB testicular seminoma were identified between 1988 and 2003 using the Surveillance, Epidemiology, and End Results (SEER) database.Results Median follow-up was 10 years. Patients with stage IIA disease underwent RT more frequently than those with stage IIB disease (72% vs. 46%, respectively; P<0.001). There was no significant change in RT utilization for stage IIA or IIB disease between 1988 and 2003 (P = 0.89).Conclusions Between 1988 and 2003, stage IIA patients underwent RT more often than stage IIB patients in the United States. There was no significant change in RT utilization for stage IIA or IIB disease during this time period. Based on reports describing excellent progression-free survival with cisplatin-based chemotherapy, this approach has increased in popularity since 2003 and may eventually become the most popular treatment approach for both stage IIA and IIB testicular seminoma.

Therapy of clinical stage IIA and IIB seminoma: a systematic review

“…Seven comparative studies met our inclusion criteria. These were published between 2011 and 2017 [10][11][12][13][14][15][16] (see Table 1). There were one prospective and six retrospective trials including a total of 5049 assessable CS IIA/B patients (CS IIA: 2840; CS IIB: 2209).…”

“…Concerning CT, only three studies reported on CT regimens with EP (etoposide/cisplatin), EP or BEP (bleomycin/etoposide/cisplatin) and EP, HOP (ifosfamide, vincristine, cisplatin), PVB (cisplatin, vinblastine, bleomycin) or VAB (vinblastine, cyclophosphamide, dactinomycin, bleomycin) being used [10][11][12]. Of note, two studies used "no RT" as comparator to patients receiving RT, however did not further define "no RT" [13,16]. Across studies, the median follow-up ranged between 3.8 and 10 years.…”

“…Patel et al reported 5-15-year OS rates for CS IIA patients of 95.8%-94.1% and for CS IIB patients of 95.9%-87.2% [16]. The other four studies described treatment specific OS data for CS IIA and CS IIB patients [10,[13][14][15]. In CS IIA patients, the 5-year OS rates following RT were 96%-100% and for CT or "no RT" 88%-100%.…”

“…All studies included in this systematic review assessed OS as an endpoint and it is obvious that cure rates are unanimously high together with an extremely low rate of cancer-associated deaths [9][10][11][12][13][14][15]. Three studies reported on CSS [10,13,16]. However, only Tandstad et al and Ahmed et al discriminated for CS IIA or IIB and for RT or CT/"no RT".…”

“…5-year CSS ranged from 97 to 100% in CS IIA patients treated with RT versus 96%-100% for CS IIA patients treated with CT/ no RT [10,13]. For CS IIB patients, CSS ranged from 98 to 100% for RT and from 98 to 100% for CT/no RT [10,13] Ahmed et al found a statistically significant difference regarding OS for patients who did not receive RT [13]. Nevertheless, these results must be interpreted cautiously as there are certain limitations to the study, the most important being that "other approaches than RT" are not defined and that data on doses in the SEER database are missing (see Suppl.…”