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Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy : A report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA)

Tandstad, Torgrim; Ståhl, Olof LU ; Dahl, O.; Haugnes, H. S.; Håkansson, U. LU ; Karlsdottir, A.; Kjellman, A.; Langberg, C. W.; Laurell, A. LU and Oldenburg, J., et al. (2016) In Annals of Oncology 27(7). p.1299-1304
Abstract

Background: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter >4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. Patients and methods: From 2007 to 2010, 897 patients were included in a prospective, population-based, riskadapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n=469) or surveillance (n=422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. Results: At a median follow-up of 5.6 years, 69 relapses have... (More)

Background: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter >4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. Patients and methods: From 2007 to 2010, 897 patients were included in a prospective, population-based, riskadapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n=469) or surveillance (n=422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. Results: At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis [hazard ratio (HR) 1.9, P = 0.011] and tumor diameter >4 cm (HR 2.7, P <0.001) were identified as risk factors predicting relapse. In patients without risk factors, the relapse rate (RR) was 4.0% for patients managed by surveillance and 2.2% in patients receiving adjuvant carboplatin. In patients with one or two risk factors, the RR was 15.5% in patients managed by surveillance and 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin 4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.

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Contribution to journal
publication status
published
subject
keywords
Adjuvant carboplatin, Prognostic factors, Risk-adapted, Seminoma, Surveillance, Testicular cancer
in
Annals of Oncology
volume
27
issue
7
pages
6 pages
publisher
Oxford University Press
external identifiers
  • Scopus:84977139074
ISSN
0923-7534
DOI
10.1093/annonc/mdw164
language
English
LU publication?
yes
id
3e3d6197-3796-4f8a-8790-eb4fe9ad479c
date added to LUP
2016-07-19 13:32:37
date last changed
2016-12-04 04:52:59
@misc{3e3d6197-3796-4f8a-8790-eb4fe9ad479c,
  abstract     = {<p>Background: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter &gt;4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. Patients and methods: From 2007 to 2010, 897 patients were included in a prospective, population-based, riskadapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n=469) or surveillance (n=422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. Results: At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis [hazard ratio (HR) 1.9, P = 0.011] and tumor diameter &gt;4 cm (HR 2.7, P &lt;0.001) were identified as risk factors predicting relapse. In patients without risk factors, the relapse rate (RR) was 4.0% for patients managed by surveillance and 2.2% in patients receiving adjuvant carboplatin. In patients with one or two risk factors, the RR was 15.5% in patients managed by surveillance and 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin 4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.</p>},
  author       = {Tandstad, Torgrim and Ståhl, Olof and Dahl, O. and Haugnes, H. S. and Håkansson, U. and Karlsdottir, A. and Kjellman, A. and Langberg, C. W. and Laurell, A. and Oldenburg, J. and Solberg, A. and Söderström, K. and Stierner, U. and Cavallin-Ståhl, E. and Wahlqvist, R. and Wall, N. and Cohn-Cedermark, G.},
  issn         = {0923-7534},
  keyword      = {Adjuvant carboplatin,Prognostic factors,Risk-adapted,Seminoma,Surveillance,Testicular cancer},
  language     = {eng},
  month        = {07},
  number       = {7},
  pages        = {1299--1304},
  publisher    = {ARRAY(0xa65a4c8)},
  series       = {Annals of Oncology},
  title        = {Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy : A report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA)},
  url          = {http://dx.doi.org/10.1093/annonc/mdw164},
  volume       = {27},
  year         = {2016},
}