Management of Seminomatous Testicular Cancer: A Binational Prospective Population-Based Study From the Swedish Norwegian Testicular Cancer Study Group

Abstract

An international, population-based treatment protocol for testicular seminoma is feasible with excellent results. Surveillance remains a good option for CS1 patients. No factors predicted relapse in CS1 patients on surveillance. Despite resulting in a lower rate of relapse than with adjuvant carboplatin, adjuvant radiotherapy has been abandoned in the Swedish and Norwegian Testicular Cancer Project (SWENOTECA) as a recommended treatment option because of concerns of induction of secondary cancers. The higher number of relapses in radiotherapy-treated CS2A patients when compared with chemotherapy-treated CS2A/B patients is of concern. Late toxicity of cisplatin-based chemotherapy versus radiotherapy must be considered in CS2A patients.

Classification, epidemiology and therapies for testicular germ cell tumours

“…The 2 most important factors associated with poor prognosis includes the presence of rete-testis invasion and tumours size of ≥ 4 cm. The overall cancer-specific survival rate reported with surveillance performed by experienced centres is 97-100% for seminoma stage I (Warde et al, 1998;Aparicio et al, 2003;Tandstad et al, 2011). The main drawback of surveillance is the need for more intensive follow-up, especially with repeated imaging examinations of the retroperitoneal lymph nodes, for at least 5 years after orchidectomy.…”

Recommendations for followup of stage I and II seminoma: The Princess Margaret Cancer Centre approach

“…9,15,23,32 At the Princess Margaret Cancer Centre, 23 similar to the Danish cohort study, 9 retroperitoneal metastases either in isolation or with synchronous pelvic or inguinal metastases, accounted for 93% of relapses. Abdominopelvic CT is the main method of detecting infradiaphragmatic relapses in 85 -99% of surveillance cases.…”

“…Other studies of radiotherapy for stage II seminoma describe relapses up to 6 years from treatment. 4,32,64,65 Similar to our stage I surveillance program, we continue to follow patients to 9 years.…”

“…56 The literature guiding followup after carboplatin is sparse. Based on the similar pattern of relapse to the retroperitoneum as for surveillance, 32,48,[56][57][58][59][60][61] following adjuvant carboplatin we recommend 6-monthly abdominal imaging for the first 3 years. Of the 27 relapses reported in the MRC TE19 trial, 67% were to the retroperitoneum, 3% to the supradiaphragmatic site and there were no cases of isolated pelvic relapse.…”

“…12,70,73,74 Once there is no evidence of active disease, our followup protocol for advanced seminoma is the same as that for non-seminomatous germ cell tumors treated with chemotherapy (Table 3). Patients may be at risk of both local and distant relapse most commonly within 2 years of treatment, 3,32 and imaging includes 6-monthly CT scans of the chest, abdomen and pelvis for the first 2 years, then at 5 and 9 years. As elevated STMs may be one of the first signs of relapse in initial advanced disease, the ASCO guidelines recommend regular monitoring of STMs during followup, and we also measure STMs after chemotherapy for advanced seminoma.…”