Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ-cell tumour: results from a 17-year UK experience

Chau, Caroline; Cathomas, Richard; Wheater, Matthew; Klingbiel, Dirk; Fehr, Martin; Bennett, J.; Markham, H. C.; Lee, C.; Crabb, Simon J.; Geldart, T.

doi:10.1093/annonc/mdv254

Cited by 40 publications

(36 citation statements)

References 16 publications

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“…4,5,[10][11][12] The timing and location as well as the treatments and respective outcomes of such relapses have not been exclusively studied so far. In particular, whether the prognosis of patients with relapse is compromised by previous adjuvant treatment remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Fischer

Tandstad

Wheater

et al. 2017

JCO

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Purpose Adjuvant carboplatin is one of three management strategies that may follow inguinal orchiectomy in clinical stage I seminoma. However, little is known about the outcome of patients who experience a relapse after such treatment. Patients and Methods Data from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 centers/groups from 20 countries were collected and retrospectively analyzed. Primary outcomes were disease-free survival and overall survival. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. Results With a median follow-up of 53 months (95% CI, 48 to 60 months) the 5-year diseasefree survival was 82% (95% CI, 77% to 89%), and the 5-year overall survival was 98% (95% CI, 95% to 100%). The median time from orchiectomy to relapse was 19 months (95% CI, 17 to 23 months); 15% (95% CI, 10% to 21%) of relapses occurred > 3 years after treatment. The majority of relapses were detected by computed tomography scan during routine follow-up, 98% in the International Germ Cell Cancer Collaborative Group good prognosis group. Chemotherapy was administered to 92% of patients, mostly as standard first-line treatment corresponding to stage; 8% of patients had additional local treatments. Only 28 patients experienced a second relapse. At last follow-up, 174 (94%) of 185 patients were alive without disease, and four patients with disease. Seven patients died, three of whom due to progressive disease. Conclusion Within the limitations of a retrospective analysis, the results suggest that the majority of patients who experience a relapse after adjuvant carboplatin for clinical stage I seminoma can be successfully treated with a cisplatin-based chemotherapy regimen adequate for stage. Because 15% of the relapses occurred > 3 years after adjuvant treatment, a minimum of 5 years follow-up is recommended. Patients and MethodsData from 185 patients who relapsed after adjuvant carboplatin between January 1987 and August 2013 at 31 centers/groups from 20 countries were collected and retrospectively analyzed. Primary outcomes were disease-free survival and overall survival. Secondary outcomes were time to, stage at, and treatment of relapse as well as rate of subsequent relapses. ResultsWith a median follow-up of 53 months (95% CI, 48 to 60 months) the 5-year disease-free survival was 82% (95% CI, 77% to 89%), and the 5-year overall survival was 98% (95% CI, 95% to 100%). The median time from orchiectomy to relapse was 19 months (95% CI, 17 to 23 months); 15% (95% CI, 10% to 21%) of relapses occurred . 3 years after treatment. The majority of relapses were detected by computed tomography scan during routine follow-up, 98% in the International Germ Cell Cancer Collaborative Group good prognosis group. Chemotherapy was administered to 92% of patients, mostly as standard first-line treatment corresponding to stage; 8% of patients had additional local treatments. Only 28 patients experienced a second relapse. At last ...

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Section: Introductionmentioning

confidence: 99%

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Fischer

Tandstad

Wheater

et al. 2017

JCO

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“…57 Of the 21 relapses in that series, two mediastinal recurrences were reported but both occurred with synchronous retroperitoneal disease. We do not recommend regular CXR following adjuvant carboplatin based on the very low rates of isolated chest relapse.…”

Section: Cuaj -Reviewmentioning

confidence: 86%

“…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.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

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

Lieng

Warde

Bedard

et al. 2017

CUAJ

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Testicular seminoma most commonly affects young men and is associated with favourable prognosis. Various followup schedules and imaging protocols for testicular seminoma have been described without overall consensus. We reviewed the literature together with our experience at the Princess Margaret Cancer Centre and present an evidence-based followup approach for patients with stage I and II seminoma.

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“…Selvi (12) claimed that the timing of CT does not affect oncological outcomes, but in practice they recommend initiating CT within the first 60 days after orchiectomy.…”

Section: Discussionmentioning

confidence: 99%

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

Aydın¹,

Bolat²,

Taşlı³

et al. 2018

uob

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IntroductionTesticular cancer accounts for 1-1.5% of all cancers in men and 5% of male urological malignancies. It is usually seen between the ages of 15 and 35. In the USA, it is the most common malignancy among men aged 20-40 years and the second most common malignancy after leukemia among adolescents aged 15-19 years. The prevalence of bilateral germ cell tumor (GCT) is 2.5%, with 0.6% of these being synchronous tumors and 1.9% being metachronous contralateral tumors (1).The vast majority (90-95%) of testicular tumors are GCTs. The most common histological type of GCT is seminoma (55%), which peaks between the ages of 30-40 years. Non-seminomas account for 40% and peak between the ages of 20-30 years (2). Stage 1 seminomas comprise the majority (80-85%) of GCTs diagnosed in daily practice (3,4). The 10-year overall Objective: Treatment modalities applied after orchiectomy in early-stage germ cell tumors (GCTs) include significant changes in each new study. In this study we reevaluated the treatment approaches used in our hospital between 2010-2014 according to current guidelines. Materials and Methods: We retrospectively evaluated the oncologic treatments and follow-up data of 32 patients who underwent radical orchiectomy between January 2010 and December 2014 due to testicular tumor and were diagnosed with early stage GCT in the Urology Clinic of Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital of University of Health Sciences. Results: Of 19 patients diagnosed with stage 1 seminomas, 3 patients in the low risk group were followed. Of 4 patients who received single-dose carboplatin therapy, 2 were at low risk and 2 were at high risk. Therefore, 2 patients at low-risk had overtreatment. Twelve patients were treated with radiotherapy (RT) that was no longer recommended in guidelines after 2014. Two patients in the low risk group of stage 1 non-seminoma were followed. One of them had recurrence at 12 months, and received 3 cycles of bleomycin + etoposide + cisplatin (BEP) according to current guidelines. Four patients with stage 1 non-seminoma underwent 2 cycles of BEP because they were considered at high risk. These patients are now recommended to receive 1 cycle BEP according to the current guidelines. While 4 patients with stage 1 mixed GCT were followed because of low risk, one patient was administered 2 cycle of BEP based on the old guidelines, at that time because of high risk. In the seminoma group that was administered RT, acute myeloblastic leukemia and oligospermia toxicity were detected, but these were not observed in the carboplatin group. One of high-risk non-seminoma patients who received 2 doses of BEP developed Myelodysplastic syndrome. Conclusion: Early-stage GCTs have high cancer-specific and overall survival rates with appropriate treatment approaches. Although there are still controversial issues regarding their management, treatment approaches are changing with each study. Therefore, it is crucial to remain informed about current international guidelines and...

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Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ-cell tumour: results from a 17-year UK experience

Abstract: Overall results for this large cohort of patients confirm an excellent prognosis for these patients with outcomes equivalent to those seen in prospective clinical trials. Increasing tumour size alone appears to be associated with an increased risk of post chemotherapy relapse.

Cited by 40 publications

References 16 publications

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma

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

A Rare Tumor: Small Cell Prostate Carcinoma Case Report

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