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)

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Torgrim Tandstad
  • Olof Ståhl
  • O. Dahl
  • H. S. Haugnes
  • U. Håkansson
  • A. Karlsdottir
  • A. Kjellman
  • C. W. Langberg
  • A. Laurell
  • J. Oldenburg
  • A. Solberg
  • K. Söderström
  • U. Stierner
  • E. Cavallin-Ståhl
  • R. Wahlqvist
  • N. Wall
  • G. Cohn-Cedermark
Organisations
External organisations
  • St. Olav’s University Hospital
  • Skåne University Hospital
  • Haukeland University Hospital
  • University Hospital of North Norway
  • Karolinska University Hospital
  • Uppsala University Hospital
  • University of Oslo
  • Norrland University Hospital
  • University of Gothenburg
  • Linköping University Hospital
  • Karolinska Institutet
  • Oslo university hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology

Keywords

  • Adjuvant carboplatin, Prognostic factors, Risk-adapted, Seminoma, Surveillance, Testicular cancer
Original languageEnglish
Article numbermdw164
Pages (from-to)1299-1304
Number of pages6
JournalAnnals of Oncology
Volume27
Issue number7
Publication statusPublished - 2016 Jul 1
Publication categoryResearch
Peer-reviewedYes