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

Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ cell tumour: results from a 17 year UK experience
Treatment outcome and patterns of relapse following adjuvant carboplatin for stage I testicular seminomatous germ cell tumour: results from a 17 year UK experience
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.
1569-8041
1865-1870
Chau, C.
bc5b21b2-4974-4992-806f-61e90fc5ea63
Cathomas, R.
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Wheater, M.
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Klingbiel, D.
302e382f-ac9d-4b0a-8ea8-0178dd2164ea
Fehr, M.
37498fb2-9652-4b9e-8255-763cb4455e77
Bennett, J.
597dc7ed-0dfd-4b22-a670-b05549d5c08d
Markham, H.
de7b2315-6701-4747-aa92-aa8cef4a551f
Lee, C.
a3f55150-0839-4f1f-989b-812ed39eea41
Crabb, S.J.
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Geldart, T.
829fdbee-84dd-4825-b5eb-0e6e859ba9ff
Chau, C.
bc5b21b2-4974-4992-806f-61e90fc5ea63
Cathomas, R.
b6fe84bf-f013-404f-ade4-fa9556b77762
Wheater, M.
3691c3d8-8589-4693-a0dc-c6a8648cd7df
Klingbiel, D.
302e382f-ac9d-4b0a-8ea8-0178dd2164ea
Fehr, M.
37498fb2-9652-4b9e-8255-763cb4455e77
Bennett, J.
597dc7ed-0dfd-4b22-a670-b05549d5c08d
Markham, H.
de7b2315-6701-4747-aa92-aa8cef4a551f
Lee, C.
a3f55150-0839-4f1f-989b-812ed39eea41
Crabb, S.J.
bcd1b566-7677-4f81-8429-3ab0e85f8373
Geldart, T.
829fdbee-84dd-4825-b5eb-0e6e859ba9ff

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)

Record type: Article

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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e-pub ahead of print date: 2 June 2015
Published date: 2 June 2015
Organisations: Cancer Sciences

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Local EPrints ID: 377810
URI: https://eprints.soton.ac.uk/id/eprint/377810
ISSN: 1569-8041
PURE UUID: 5f727724-8b09-48e4-993f-4e62564cd6d8

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Date deposited: 23 Jun 2015 12:15
Last modified: 17 Jul 2017 20:57

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Contributors

Author: C. Chau
Author: R. Cathomas
Author: M. Wheater
Author: D. Klingbiel
Author: M. Fehr
Author: J. Bennett
Author: H. Markham
Author: C. Lee
Author: S.J. Crabb
Author: T. Geldart

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