Title |
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)
|
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Published in |
Annals of Oncology, April 2016
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DOI | 10.1093/annonc/mdw164 |
Pubmed ID | |
Authors |
T. Tandstad, O. Ståhl, O. Dahl, H.S. Haugnes, U. Håkansson, Å. 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, on behalf of SWENOTECA |
Abstract |
The purpose of the protocol was to reduce the treatment burden in clinical stage I (CS I) 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 >4cm, and to evaluate the efficacy of one course of adjuvant carboplatin. From 2007-2010, 897 patients were included in a prospective, population-based, risk-adapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n=469) or surveillance (n=422). In addition, results from 221 patients receiving carboplatin between 2004-2007 are reported. At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis (HR 1.9, p=0.011) and tumor diameter >4 cm (HR 2.7, p<0.001) were identified as risk factor predicting relapse. In patients without risk factors the relapse rate (RR) was 4.0% for patients managed by surveillance compared to 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 compared to 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin <7xAUC compared to patients receiving ≥7xAUC. Stromal invasion in the rete testis and tumor diameter >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. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 2 | 25% |
Spain | 1 | 13% |
France | 1 | 13% |
Unknown | 4 | 50% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 6 | 75% |
Practitioners (doctors, other healthcare professionals) | 1 | 13% |
Scientists | 1 | 13% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 72 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 14 | 19% |
Other | 12 | 17% |
Student > Doctoral Student | 8 | 11% |
Student > Postgraduate | 6 | 8% |
Student > Ph. D. Student | 6 | 8% |
Other | 9 | 13% |
Unknown | 17 | 24% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 45 | 63% |
Chemical Engineering | 1 | 1% |
Biochemistry, Genetics and Molecular Biology | 1 | 1% |
Sports and Recreations | 1 | 1% |
Agricultural and Biological Sciences | 1 | 1% |
Other | 2 | 3% |
Unknown | 21 | 29% |