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Annals of Oncology 14:867-872, 2003
© 2003 European Society for Medical Oncology

Original Paper

Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma

J. Aparicio1,+, X. García del Muro2, P. Maroto3, L. Paz-Ares4, E. Alba5, A. Sáenz6, J. Terrasa7, A. Barnadas8, D. Almenar9, J. A. Arranz10, M. Sánchez11, A. Fernández12, J. Sastre13, J. Carles14, J. Dorca15, J. Gumà16, A. L. Yuste1 and J. R. Germà2,§

1 Hospital Universitario La Fe, Valencia; 2 Institut Catalá d’Oncologia, Barcelona; 3 Hospital de Sant Pau, Barcelona; 4 Hospital 12 de Octubre, Madrid; 5 Hospital Clínico Universitario, Málaga; 6 Hospital Clínico, Zaragoza; 7 Hospital Son Dureta, Mallorca; 8 Hospital Germans Trias i Pujol, Badalona; 9 Hospital Doctor Peset, Valencia; 10 Hospital Gregorio Marañón, Madrid; 11 Hospital Donostia, San Sebastián; 12 Hospital General, Albacete; 13 Hospital Clínico San Carlos, Madrid; 14 Hospital del Mar, Barcelona; 15 Hospital Josep Trueta, Girona; 16 Hospital Universitari Sant Joan, Reus, Spain

Received 21 October 2002; revised 16 December 2002; accepted 23 January 2003

Background:

After decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting.

Patients and methods:

From 1994 to 1999, 203 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance.

Results:

Median follow-up was 52 months (range 14–92). Relapses were observed in two (3.3%) patients treated with carboplatin and in 23 patients (16.1%) on surveillance, with a median time to recurrence of 11 months (range 3.9–39.6). All relapsing patients were rendered disease-free, mainly with cisplatin-based chemotherapy. Four patients died from tumor-unrelated causes. Actuarial 5-year overall survival was 96.7% and cause-specific survival was 100%. Five-year disease-free survival was 83.5% for patients on surveillance, and 96.6% for those receiving carboplatin.

Conclusions:

This dual treatment policy is feasible in a multicenter setting and preserves 70% of patients from adjuvant chemotherapy. Single-agent carboplatin is effective in reducing the relapse rate in patients with high-risk stage I seminoma. A better definition of local risk features would probably improve patient selection, thus minimizing the incidence of recurrences on surveillance.

Key words: adjuvant carboplatin, prognostic factors, stage I seminoma, surveillance


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