Surveillance in stage I seminoma patients: a long-term assessment.

BACKGROUND: Following orchidectomy patients with stage I seminoma of the testis may be managed by either surveillance or adjuvant treatment. In view of the very high cure rate, it is important to analyse long-term outcomes.
OBJECTIVE: To provide data to advise patients on treatment burden and risk of recurrence associated with surveillance. DESIGN, SETTING, AND PARTICIPANTS: We audited the case records of 164 stage I seminoma patients registered at the Royal Marsden Hospital who were managed with a surveillance policy between 1980 and 2004 and followed for 1-20 yr (median: 13.5 yr). MEASUREMENTS: All treatments and patterns of relapse were documented. RESULTS AND LIMITATIONS: Twenty-two of 164 (13%) patients had relapsed at a median of 15.5 mo (range: 6-55 mo) from orchidectomy. Eighteen relapses appeared to be confined to the para-aortic nodes, but 6 of the 13 (46%) men treated with only para-aortic radiotherapy suffered a further relapse at another site. The disease-specific mortality was 1.3%. In the complete series of 164 patients, a total of 50 cycles of chemotherapy and 26 courses of radiotherapy was administered, representing an average of 0.46 "treatment units" per patient or an average of 3.45 treatment units per relapsing patient. The total number of treatment days was 390 d for radiotherapy and 133 d for chemotherapy, representing an average of 3.2 d per patient or 23.8 d per relapsing patient. This was a single-centre series extending back to the 1980s. Imaging and treatment protocols have advanced since then.
CONCLUSIONS: Surveillance postorchidectomy is a safe practice in the long term, and the majority of patients can avoid further treatment. There is the risk that those who do relapse face a higher burden of treatment than would be required if adjuvant treatment had been given.