1. Susman, Ed

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SINGAPORE-Long-term follow-up of men diagnosed with Stage 1 seminoma indicates that treatment with chemotherapy or radiation results in control of the disease-far better than surveillance and orchiectomy, doctors reported here at the 2015 European Society for Medical Oncology Asia Cancer Symposium.

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"Stage 1 seminoma prognosis is excellent," said Nicoleta Antone, MD, a specialist in Medical Oncology at the Prof. Dr. Ion Chiricuta Institute of Oncology in Cluj-Napoca, in Romania, at her poster presentation. "The rate of curability for adjuvant treatment is high, with the overall disease-free survival at 10 years with adjuvant chemotherapy reaching 98 percent," she told OT.


Study Statistics

There were 61 patients in the study who elected to undergo chemotherapy following surgery.


The disease-free survival at 10 years was 93 percent among the 46 patients who elected radiotherapy as an adjuvant treatment following surgery. However, the patients who were treated with orchiectomy, then watched without chemotherapy or radiotherapy, had a disease-free survival of 37 percent at 10 years, she said.


"Overall survival was 94 percent at 10 years. Management decision should rest on the likely morbidity and convenience of different treatment choices," Antone suggested.


Of the 150 patients in the study, 138 remain alive, Antone reported.


As a medical oncologist, she said she is biased toward recommending chemotherapy for her patients who present with Stage 1 seminoma. "I would offer them one cycle of carboplantin chemotherapy," she said. "However, the choice of treatment is really determined by the patient's risk factors and performance status."


What Does it Mean?

In commenting on the research, Elizabeth Kavaler, MD, a urology specialist, Lenox Hill Hospital, New York City, told OT, "Stage 1 seminoma does have an excellent prognosis. Now that we know that it can be controlled, our efforts are aimed at reducing the morbidity of our treatments.


"One cycle of chemotherapy gave their patients a 98 percent five-year survival," she said. "These results suggest that reducing the exposure to chemotherapy to these young men will not adversely impact on their survival."


Study Details

The retrospective study conducted by researchers at the Transylvania institute included 150 patients with a median age of 36 years who were diagnosed with Stage 1 testicular seminoma between January 1982 and January 2009. The median follow-up was 135.8 months, ranging from three months to 233 months. Adjuvant treatment was either one cycle of carboplatin at a dose of AUC 7, two cycles of carboplatin AUC 6, radiotherapy, or surveillance.


At baseline, 93 of the patients were in ECOG performance status 0; 53 patients were in ECOG performance status 1; and four patients were considered ECOG performance status 4. There were 65 patients who were diagnosed with Stage 1A seminoma; 69 patients diagnosed with Stage 1B seminoma; and 16 patients with Stage 1S seminoma.

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In 80 percent of the patients, noted Antone, there were no relapses. Metastases were observed in six patients; pelvic or lomboaortic lymph nodes were involved in 21 patients; two patients experienced metastatic and node relapses; and one seric relapse was reported.


"Chemotherapy toxicity was moderate," Antone said. There were no grades 3 or 4 toxicities observed in the series; the main toxicity for carboplatin-treated patients was thrombocytopenia, which was experienced by 6.7 percent of the men in the study. She said that 3.7 percent of the patients experienced anemia; 3.3 percent experienced leukopenia; and another 3.4 percent of patients reported nausea and vomiting.


Discussions about male fertility down the road were not common when patients were treated in the 1980s, Antone said, adding, "but nowadays we do have those conversations with our patients and we have followed them. Some of them have fathered children; some have even had two children. So, you see, fertility can be preserved even with curative treatments."