Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study

Steiner, Hannes; Höltl, Lorenz; Wirtenberger, Walter; Berger, Andreas; Bartsch, Georg; Hobisch, Alfred

doi:10.1016/s0090-4295(02)01708-9

Cited by 65 publications

(19 citation statements)

References 26 publications

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“…These data are in line with several retrospective studies assessing carboplatin-based chemotherapy, which is less toxic than cisplatin, as an effective treatment option for patients with CS I seminoma [30, 31]. The mild side effects, most commonly thrombocytopenia, and the applicability of single-agent carboplatin therapy on an outpatient basis have made this treatment option very attractive.…”

Section: Adjuvant Chemotherapysupporting

confidence: 78%

New Guidelines for Clinical Stage I Testicular Seminoma?

Christoph¹,

Weikert²,

Miller³

et al. 2005

Oncology

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Clinical stage I (CS I) seminoma has been the subject of various studies aimed at finding the ideal treatment. Due to its high radiosensitivity, radiotherapy has been the standard approach for decades. However, the fact that CS I seminoma has a recurrence rate of only 15–20% has prompted many suggestions for better treatment stratification offering surveillance therapy for a subgroup of patients. Moreover, carboplatinum-based monochemotherapy has been the topic of various retrospective studies demonstrating equal effectiveness for adjuvant chemotherapy with one cycle of carboplatin. Since seminoma affects men in their mid-30s, only few reports have been published on long-term survival with reference to radiotoxicity and secondary malignancies. Long-term side effects and secondary malignancies pose an increasing problem for long-term survivors of primary malignancies treated by chemo- or radiotherapy. This becomes evident after a follow-up of 15 years. Since recent studies have disclosed unexpectedly high long-term morbidity and mortality after irradiation, this article critically reviews the value of radiotherapy and carboplatinum-based chemotherapy as equally effective treatment options for CS I seminoma.

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Section: Adjuvant Chemotherapysupporting

confidence: 78%

New Guidelines for Clinical Stage I Testicular Seminoma?

Christoph¹,

Weikert²,

Miller³

et al. 2005

Oncology

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“…Chemotherapy has also been reported to lower the incidence of metachronous BGCT, with an estimated risk of recurrent intraepithelial germ-cell neoplasia of 21 and 42% at 5 and 10 years, respectively (Oliver et al, 1996). This finding associated with the long-term experience with single-agent carboplatin for clinical stage I seminoma (Steiner et al, 2002) may lead to recommendations for treatment with this cytotoxic agent rather than radiotherapy for patients presenting with seminoma below 30 years of age.…”

Section: Discussionmentioning

confidence: 98%

Bilateral germ-cell tumours: 22-year experience at the Institut Gustave Roussy

et al. 2004

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The aim of this study was to describe the incidence, clinical and histological characteristics, treatment and long-term follow-up of bilateral germ-cell tumours (BGCT) of the testis in order to determine in what respects they differ significantly from unilateral germcell tumours. In all, 31 patients with BGCT had metachronous tumours and 14 had synchronous tumours. Among the metachronous tumours, 61% occurred more than 5 years after the first tumour. The overall incidence of BGCT in patients with testicular germ-cell tumours (TGCT) was 1.9%. The incidence was 3.2% in patients presenting with a seminoma and 1.4 % in patients presenting with a nonseminomatous germ-cell tumour (NSGCT). Patients under 30 years of age at the time of the initial diagnosis had a higher incidence of bilateral tumours compared with older men. The outcome of BGCT was excellent. A high association was found between BGCT, sterility and suspected genetic risk factors for TGCT. These results argue against a systematic contralateral biopsy at diagnosis of first TGCT in all patients, but emphasise the importance of patient education and of the need to better identify patients at risk for a second TGCT. Therapeutic indications for synchronous BGCT, including conservative treatment, need to be better defined. Testicular germ-cell tumour (TGCT) is a rare disease with an estimated incidence of five out of 100 000. An increase of more than 50% has been demonstrated in all Western countries during the last decades (Grenlee et al, 2001). Several risk factors for developing a TGCT have been identified, uppermost among which is a previous TGCT (Osterlind et al, 1991). The incidence of bilateral testicular germ-cell tumour (BGCT) ranges between 1 and 5% in previously published large series (Bokemeyer et al, 1993;Dieckmann et al, 1993Dieckmann et al, , 1999Dieckmann et al, , 2002Heidenreich et al, 1995Heidenreich et al, , 1997Heidenreich et al, , 2000Gerl et al, 1997;Tekin et al, 2000;Geczi et al, 2001;Ondrus et al, 2001;Che et al, 2002;Ohyama et al, 2002). The charts of 2383 consecutive patients treated at the Institut Gustave Roussy over a 22-year period were analysed to estimate the incidence of BGCT, to identify potential risk factors and to evaluate the long-term survival of patients with BGCT. PATIENTS AND METHODSBetween 1979 and 2002, 2383 patients with TGCT were treated in the Adult Cancer Department at the Institut Gustave Roussy (IGR). The list of patients was obtained from a computerised database. Among these 2383 patients, 45 had a BGCT. The medical records of these 45 patients were reviewed to collect the following information: previous personal and family medical history, clinical characteristics at presentation, histopathology, treatment, interval between the development of the two tumours and follow-up.All available pathology slides were reviewed. Most patients had their orchidectomy at other institutions. Haematoxylin-and eosinstained slides of both testicular tumours were available for 36 patients, and slides of only one tumour were avai...

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“…Meanwhile the publication by Dieckmann et al [29] reporting on a relapse rate of 8.6% in 93 patients, followed up for a median of 4 years after a single course of adjuvant carboplatin in stage I seminoma, may serve as a reminder to use this treatment approach cautiously; however, the dose may have been suboptimal [11]. Steiner et al [30] treated 108 patients with two cycles of carboplatin, and with mean follow-up of 5 years, there were only two relapses. However, the prospective randomized multicenter trial of the MRC/EORTC intergroup comparing one course of single-agent carboplatin AUC 7 with para-aortic RT (optionally 20 Gy or 30 Gy) has now been closed after inclusion of 1 447 patients with preliminary results presented recently at the 2004 ASCO Annual Meeting [31]: relapse-free survival rates for radiotherapy vs. chemotherapy were 96.6% (95%CI: 95.2% to 97.6%) vs. 95.4% (93.3% to 96.9%) at 3 years (HR 1.39; 90%CI: 0.92 to 2.11; p0/0.195).…”

Section: Discussionmentioning

confidence: 99%

Adjuvant radiotherapy in stage I seminoma: Is there a role for further reduction of treatment volume?

et al. 2005

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An analysis was performed to determine whether a cranial reduction of the portals to the T11/T12 junction instead of the common T10/T11 junction would alter the outcome of patients with stage I seminoma. Of 163 consecutive patients with newly diagnosed testicular seminoma referred to the authors' institution between April 1992 and April 1999, 80 patients with stage I seminoma were treated with cranially reduced para-aortic treatment fields reaching from the top of T12 to the bottom of L4. Median total dose was 20.0 Gy (range, 19.8 Á/27.2 Gy). Patients were followed-up by the use of CT in regular intervals. After a median follow-up of 7.1 years (range, 4.1 Á/11.1 years), four patients (5%) had relapsed resulting in an actuarial 5-year relapse-free survival of 95%. No patients relapsed within the cranially reduced treatment volume above the top of T12. The cranial reduction of the para-aortic treatment fields resulted in a median reduction of treatment volume of 16% (range, 13 Á/21%). The achieved median reduction in treatment volume of 16% appears to be relevant and is not associated with an increased relapse rate. This approach is recommended in analogy to the surgical approach in NSGCT to further minimize the risk of radiation-related late effects.

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Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study

Cited by 65 publications

References 26 publications

New Guidelines for Clinical Stage I Testicular Seminoma?

New Guidelines for Clinical Stage I Testicular Seminoma?

Bilateral germ-cell tumours: 22-year experience at the Institut Gustave Roussy

Adjuvant radiotherapy in stage I seminoma: Is there a role for further reduction of treatment volume?

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