Patterns of relapse and treatment outcome after active surveillance or adjuvant carboplatin for stage I seminoma: a retrospective study of the Spanish Germ Cell Cancer Group
Por:
Aparicio J, García Del Muro X, Maroto P, Terrasa J, Castellano D, Bastús R, Gumà J, Sagastibeltza N, Durán I, Ochenduszko S, Meana JA, García-Sánchez J, Arranz JA, Gironés R and Germà JR
Publicada:
1 ene 2021
Ahead of Print:
1 may 2020
Resumen:
Purpose Active surveillance (AS) and adjuvant chemotherapy (AC) with carboplatin are valid alternatives for managing stage I seminoma, and most relapses can be cured with cisplatin-based chemotherapy. However, some reports suggest that AC may modify the classical pattern of recurrences. Methods We analyzed all relapses observed in a series of 879 patients with stage I seminoma included in 4 consecutive studies of the Spanish Germ Cell Cancer Group. After a median follow-up of 67 months, recurrences were detected in 56/467 (12%) low-risk cases on AS and 13/412 (3%) high-risk cases after AC (p < 0.001). The objective was to describe clinical features, treatment and outcome. Univariate comparisons were performed between both groups. Results No significant differences were found between relapses on AS and those after AC in terms of time to relapse (13 vs 17 months), size (26 vs 27 mm), location (retroperitoneum in 88% vs 85%), and method of detection (computed tomography in 77% vs 69%). Treatment consisted of chemotherapy (etoposide + cisplatin +/- bleomycin) in 89% and 92%, respectively. Late relapses (after > 3 years) were seen in 11% vs 7.7% (p = NS) and second or successive recurrences in 1.8 vs 23% (p < 0.05). With a median follow-up of 130 moths, two patients died of seminoma-unrelated causes (AS group) and the rest are alive and disease-free. Conclusion In the setting of a risk-adapted treatment of stage I seminoma, the administration of two courses of AC in patients with tumor size > 4 cm and/or rete testis invasion is associated with a higher incidence of second recurrences but does not significantly modify the pattern of relapses or their outcome.
Filiaciones:
Aparicio J:
Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain.
García Del Muro X:
Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
Maroto P:
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Terrasa J:
Hospital Universitario Son Espases, Palma de Mallorca, Spain
Castellano D:
Hospital Universitario 12 de Octubre, Madrid, Spain
Bastús R:
Hospital Universitari Mutua Terrassa, Terrassa, Spain
Gumà J:
Hospital Universitari Sant Joan, URV, IISPV, Reus, Spain
Sagastibeltza N:
Hospital Universitario Donostia, San Sebastián, Spain
Durán I:
Hospital Universitario Marqués de Valdecilla, Santander, Spain
:
Hospital Universitario Doctor Peset, Valencia, Spain
Meana JA:
Hospital General Universitario, Alicante, Spain
:
Hospital Arnau de Vilanova, Valencia, Spain
Arranz JA:
Hospital Universitario Gregorio Marañón, Madrid, Spain
Gironés R:
Servicio de Oncología Médica, Hospital Universitario y Politécnico La Fe, Avda. Abril Martorell 106, 46026, Valencia, Spain
Germà JR:
Institut Catalá d'Oncologia Hospitalet, IDIBELL, University of Barcelona, Barcelona, Spain
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