Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ cell tumour: results from a 17 year UK experience

Chau, C., Cathomas, R., Wheater, M., Klingbiel, D., Fehr, M., Bennett, J., Markham, H., Lee, C., Crabb, S.J. and Geldart, T. (2015) Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ cell tumour: results from a 17 year UK experience. Annals of Oncology, 26 (9), 1865-1870. (doi:10.1093/annonc/mdv254). (PMID:26037797)

Abstract

BACKGROUND: Following inguinal orchidectomy, management options for patients with stage I seminoma include initial surveillance or treatment with adjuvant radiotherapy or chemotherapy. The anticipated relapse rate for patients followed by surveillance alone is approximately 15%, with adjuvant treatment this risk is reduced to approximately 4-5% at five years. After carboplatin treatment, follow up strategies vary and there are no validated, predictive markers of relapse.

PATIENTS AND METHODS: We conducted a retrospective analysis of all patients presenting with stage I seminoma who received a single cycle of adjuvant carboplatin in South Central England between 1996 - 2013. We report on outcome and the results of univariate and multivariate analysis evaluating possible risk factors for post carboplatin relapse.

RESULTS: 517 eligible patients were identified. All underwent nuclear medicine estimation of GFR prior to treatment with carboplatin (dosed at AUC 7). With a median follow up of 47.2 months (range 0.4 - 214), 21/517 patients have relapsed resulting in a 5 year estimated relapse-free survival of 95.0% (95%CI; 92.8-97.3%). Median time to relapse was 22.7 months (range 12.5 - 109.5). Relapse beyond 3 years was rare (4/517; 0.8%). 20 of 21 (95%) relapsed patients had retroperitoneal lymph node metastases. The majority (16/21; 76%) of patients had elevated tumour markers at relapse. 20/517 (3.9%) patients developed a new contralateral testicular germ cell cancer. There were no seminoma related deaths. Tumour size was the only variable significantly associated with an increased risk of relapse.

CONCLUSIONS: Overall results for this large cohort of patients confirm an excellent prognosis for these patients with outcomes equivalent to those seen in prospective clinical trials. Increasing tumour size alone appears to be associated with an increased risk of post chemotherapy relapse.

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Contributors

Author: S.J. Crabb

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