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Outcome of men with relapse after adjuvant carboplatin for clinical stage i seminoma

Fischer, Stefanie; Tandstad, Torgrim; Wheater, Matthew; Porfiri, Emilio; Fléchon, Aude; Aparicio, Jorge; Klingbiel, Dirk; Skrbinc, Breda; Basso, Umberto and Shamash, Jonathan, et al. (2017) In Journal of Clinical Oncology 35(2). p.194-200
Abstract

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... (More)

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.

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Journal of Clinical Oncology
volume
35
issue
2
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7 pages
publisher
American Society of Clinical Oncology
external identifiers
  • scopus:85009874586
  • wos:000391382000011
ISSN
0732-183X
DOI
10.1200/JCO.2016.69.0958
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English
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yes
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35e520dd-e68e-4d0b-9ba3-86a2fc74111a
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2017-02-10 14:25:10
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2018-05-06 04:30:44
@article{35e520dd-e68e-4d0b-9ba3-86a2fc74111a,
  abstract     = {<p>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 &gt; 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 &gt; 3 years after adjuvant treatment, a minimum of 5 years follow-up is recommended.</p>},
  author       = {Fischer, Stefanie and Tandstad, Torgrim and Wheater, Matthew and Porfiri, Emilio and Fléchon, Aude and Aparicio, Jorge and Klingbiel, Dirk and Skrbinc, Breda and Basso, Umberto and Shamash, Jonathan and Lorch, Anja and Dieckmann, Klaus-Peter and Cohn-Cedermark, Gabriella and Ståhl, Olof and Chau, Caroline and Arriola, Edurne and Marti, Kalena and Hutton, Paul and Laguerre, Brigitte and Maroto, Pablo and Beyer, Jörg and Gillessen, Silke},
  issn         = {0732-183X},
  language     = {eng},
  month        = {01},
  number       = {2},
  pages        = {194--200},
  publisher    = {American Society of Clinical Oncology},
  series       = {Journal of Clinical Oncology},
  title        = {Outcome of men with relapse after adjuvant carboplatin for clinical stage i seminoma},
  url          = {http://dx.doi.org/10.1200/JCO.2016.69.0958},
  volume       = {35},
  year         = {2017},
}