Outcome of Men With Relapse After Adjuvant Carboplatin for Clinical Stage I Seminoma
Por:
Fischer, S, Tandstad, T, Wheater, M, Porfiri, E, Flechon, A, Aparicio, J, Klingbiel, D, Skrbinc, B, Basso, U, Shamash, J, Lorch, A, Dieckmann, KP, Cohn-Cedermark, G, Stahl, O, Chau, C, Arriola, E, Marti, K, Hutton, P, Laguerre, B, Maroto, P, Beyer, J, Gillessen, S
Publicada:
10 ene 2017
Resumen:
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 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 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. (C) 2016 by American Society of Clinical Oncology
Filiaciones:
Fischer, S:
Cantonal Hosp St Gallen, St Gallen, Switzerland
Tandstad, T:
St Olavs Univ Hosp, Trondheim, Norway
Wheater, M:
Southampton Univ Hosp, Southampton, Hants, England
Porfiri, E:
Birmingham Univ Hosp, Birmingham, W Midlands, England
Flechon, A:
Ctr Leon Berard, Lyon, France
Aparicio, J:
Univ Spital Zurich, Zurich, Switzerland
Hosp Univ & Politecn La Fe, Valencia, Spain
Klingbiel, D:
SAKK Coordinating Ctr, Bern, Switzerland
Skrbinc, B:
Inst Oncol, Ljubljana, Slovenia
Basso, U:
Ist Ricovero & Cura Carattere Sci, Padua, Italy
Shamash, J:
St Bartholomews Hosp, London, England
Lorch, A:
Univ Klinikum Dusseldorf, Dusseldorf, Germany
Dieckmann, KP:
Urol Clin, Hamburg, Germany
Cohn-Cedermark, G:
Karolinska Inst, S-10401 Stockholm, Sweden
Karolinska Univ Hosp, Stockholm, Sweden
Stahl, O:
Skane Univ Hosp, Lund, Sweden
Chau, C:
Southampton Univ Hosp, Southampton, Hants, England
Arriola, E:
Southampton Univ Hosp, Southampton, Hants, England
Marti, K:
Birmingham Univ Hosp, Birmingham, W Midlands, England
Hutton, P:
Birmingham Univ Hosp, Birmingham, W Midlands, England
Laguerre, B:
Ctr Eugene Marquis, Rennes, France
Maroto, P:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gillessen, S:
Cantonal Hosp St Gallen, St Gallen, Switzerland
Green Accepted
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