Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma

Horwich, A.; Dearnaley, David P.; Sohaib, Aslam; Pennert, Kjell; Huddart, Robert

doi:10.1093/annonc/mdt148

Cited by 37 publications

(23 citation statements)

References 27 publications

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“…Accumulating data on long-term morbidity, such as a higher risk of cardiovascular events and risk of second malignancies following radiotherapy, have led to concern. Most reports refer to patients irradiated with larger target volumes and higher doses, but there are also more recent studies on patients treated with more modern radiotherapy [53]. The radiation dose delivered for stage IIA and IIB is approximately 30 and 36 Gy, respectively, and the field size is enlarged.…”

Section: Treatment Of Patients With Metastatic Diseasementioning

confidence: 99%

Guidelines on Testicular Cancer: 2015 Update

Albrecht²,

et al. 2015

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Section: Treatment Of Patients With Metastatic Diseasementioning

confidence: 99%

Guidelines on Testicular Cancer: 2015 Update

Albrecht²,

et al. 2015

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“…In fact, single agent carboplatin AUC7 in CSIIA and B did not safely eradicate retroperitoneal metastases [19]. By contrast, a single cycle of neoadjuvant carboplatin before RT seemed to reduce recurrence risk compared with RT alone and permit a smaller radiation field, according to a recent single-center pilot study in 51 seminoma patients [20]. Currently, a phase II clinical trial is evaluating a sequential treatment of carboplatin AUC7 followed by involved-node RT with 30 Gy for CSIIA and 36 Gy for CSIIB seminoma (ClinicalTrials.gov Identifier: NCT01593241).…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Clinical Stage IIA-IIC Seminoma: Radiation Therapy versus Systemic Chemotherapy versus Retroperitoneal Lymph Node Dissection

2018

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Background: Clinical stage II (CSII) seminoma is defined by the presence of pure seminoma accompanied by retroperitoneal lymph node metastases. In patients with bulky disease (lymph nodes > 5 cm in diameter), platinum-based chemotherapy is the widely accepted standard of care. However, the optimal choice of treatment for CSIIA and IIB is more controversial. Methods: We performed a PubMed search using the key words stage II seminoma, BEP (cisplatin, etoposide, and bleomycin), hockey-stick radiotherapy, dog-leg radiotherapy and retroperitoneal lymph node dissection. Most relevant publications were summarized for this review. Results: To date, no randomized trials have prospectively compared radiotherapy (RT), chemotherapy (CT) and retroperitoneal lymph node dissection (RLND) for CSII seminoma. Because of the predominantly retrospective analyses and only few prospective trials data interpretation is complex. In CSIIA with lymph nodes of < 2 cm, RT and CT seem to be equally effective, while in CSIIB, a decreased number of relapses were observed in CT-treated patients. In addition, RT seems to be associated with a higher incidence of long-term sequelae when compared with CT. Conclusion: Prospective clinical trials are needed to systematically compare the different treatment modalities. De-escalation of treatment intensity without loss of efficacy is required to improve long-term outcome for this young patient population.

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“…A third alternative, the combination of one to two cycles of carboplatin prior to radiotherapy, has been shown to lower the risk of relapse in seminoma stage II with limited extent [ 41 ]. Recently, the Swiss Testicular Cancer Study Group initiated a study for stage IIA/B disease combining one course of carboplatin and node radiation.…”

Section: Stage Iia/bmentioning

confidence: 99%