Risk-adapted treatment in clinical stage I testicular seminoma: The third Spanish Germ Cell Cancer Group study
Por:
Aparicio J., Maroto P., García Del Muro X., Gumà J., Sánchez-Muñoz A., Margelí M., Doménech M., Bastús R., Fernández A., López-Brea M., Terrassa J., Meana A., Martínez Del Prado P., Sastre J., Satrústegui J.J., Gironés R., Robert L., Germà J.R.
Publicada:
1 ene 2011
Resumen:
Purpose: To confirm the efficacy of a risk-adapted treatment approach for patients with clinical stage I seminoma. The aim was to reduce both the risk of relapse and the proportion of patients receiving adjuvant chemotherapy while maintaining a high cure rate. Patients and Methods: From 2004 to 2008, 227 patients were included after orchiectomy in a multicenter study. Eighty-four patients (37%) presented no local risk factors, 44 patients (19%) had tumors larger than 4 cm, 25 patients (11%) had rete testis involvement, and 74 patients (33%) had both criteria. Only the latter group received two courses of adjuvant carboplatin, whereas the rest were managed by surveillance. Results: After a median follow-up time of 34 months, 16 relapses (7%) have been documented (15 [9.8%] among patients on surveillance and one [1.4%] among those treated with carboplatin). All relapses occurred in retroperitoneal lymph nodes, except for one case in pelvic nodes. Median node size was 25 mm, and median time to recurrence was 14 months. All patients were rendered disease-free with chemotherapy. The actuarial 3-year disease-free survival rate was 88.1% (95% CI, 82.3% to 93.9%) for patients on surveillance and 98.0% (95% CI, 94.0% to 100%) for those treated with adjuvant chemotherapy. Overall 3-year survival was 100%. Conclusion: With the limitations of the short follow-up duration, we confirm that a risk-adapted approach is effective for stage I seminoma. Adjuvant carboplatin seems adequate treatment for patients with 2 risk criteria, as is active surveillance for those with 0 to one risk factors. More reliable predictive factors are needed to improve the applicability of this model. © 2011 by American Society of Clinical Oncology.
Filiaciones:
Aparicio J.:
Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Bulevar Sur, s/n, E-46026 Valencia, Spain
Maroto P.:
Hospital de Sant Pau, Barcelona, Spain
García Del Muro X.:
Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet, Spain
Gumà J.:
Hospital Universitari Sant Joan, Reus, Spain
Sánchez-Muñoz A.:
Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
Margelí M.:
Hospital Universitari Germans Trias i Pujol, Badalona, Spain
Doménech M.:
Hospital Althaia, Manresa, Spain
Bastús R.:
Hospital Mutua de Terrassa, Terrassa, Spain
Fernández A.:
Complejo Hospitalario Universitario, Albacete, Spain
López-Brea M.:
Hospital Universitario Marqués de Valdecilla, Santander, Spain
Terrassa J.:
Hospital Son Dureta, Palma de Mallorca, Spain
Meana A.:
Hospital General, Alicante, Spain
Martínez Del Prado P.:
Hospital de Basurto, Bilbao, Spain
Sastre J.:
Hospital Clínico San Carlos, Madrid, Spain
Satrústegui J.J.:
Instituto Oncológico de Guipúzcoa, San Sebastián, Spain
Gironés R.:
Hospital Luis Alcañiz, Xátiva, Spain
Robert L.:
Hospital de Sant Pau, Barcelona, Spain
Germà J.R.:
Idibell-Institut Catalá d'Oncologia Duran i Reynals, L'Hospitalet, Spain
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