A Horwich1, D P Dearnaley, A Sohaib, K Pennert, R A Huddart. 1. Division of Radiotherapy & Imaging, The Institute of Cancer Research and Urological Oncology Unit, The Royal Marsden NHS Trust, Sutton, UK. alan.horwich@icr.ac.uk
Abstract
BACKGROUND: Extended field radiotherapy is a standard of care for low volume stage II testicular seminoma. We hypothesized that neoadjuvant carboplatin might reduce the recurrence risk. PATIENTS AND METHODS: In a single-arm study, 51 patients were treated between May 1996 and November 2011 with a single cycle of carboplatin followed by radiotherapy. The radiation field was reduced from an extended abdomino-pelvic field to just the para-aortic region, and the radiation dose from 35 Gy to 30 Gy in 39 patients. RESULTS: After a median follow-up of 55 months (range 8-151 months) with 38 (74%) of the patients having been followed for >2 years, there have been no relapses (95% confidence limits of 5-year relapse-free survival of 93%-100%). Toxicity has been low with grade 3 toxicity limited to four patients with grade 3 haematological toxicity (with no clinical sequelae) and one patient with grade 3 nausea (during radiotherapy). No patients experienced grade 4 toxicity. CONCLUSIONS: The results of this pilot study suggest that a single cycle of neoadjuvant carboplatin before radiotherapy may reduce recurrence risk compared with radiotherapy alone and permit a smaller radiation field, and this approach is proposed for further investigation.
BACKGROUND: Extended field radiotherapy is a standard of care for low volume stage II testicular seminoma. We hypothesized that neoadjuvant carboplatin might reduce the recurrence risk. PATIENTS AND METHODS: In a single-arm study, 51 patients were treated between May 1996 and November 2011 with a single cycle of carboplatin followed by radiotherapy. The radiation field was reduced from an extended abdomino-pelvic field to just the para-aortic region, and the radiation dose from 35 Gy to 30 Gy in 39 patients. RESULTS: After a median follow-up of 55 months (range 8-151 months) with 38 (74%) of the patients having been followed for >2 years, there have been no relapses (95% confidence limits of 5-year relapse-free survival of 93%-100%). Toxicity has been low with grade 3 toxicity limited to four patients with grade 3 haematological toxicity (with no clinical sequelae) and one patient with grade 3 nausea (during radiotherapy). No patients experienced grade 4 toxicity. CONCLUSIONS: The results of this pilot study suggest that a single cycle of neoadjuvant carboplatin before radiotherapy may reduce recurrence risk compared with radiotherapy alone and permit a smaller radiation field, and this approach is proposed for further investigation.
Authors: Robert J Hamilton; Christina Canil; Noa Shani Shrem; Kopika Kuhathaas; Maria Di Jiang; Peter Chung; Scott North; Piotr Czaykowski; Sebastien Hotte; Eric Winquist; Christian Kollmannsberger; Armen Aprikian; Denis Soulières; Scott Tyldesley; Alan I So; Nicholas Power; Ricardo A Rendon; Martin O'Malley; Lori Wood; Michael A S Jewett Journal: Can Urol Assoc J Date: 2022-06 Impact factor: 2.052
Authors: Gregory J Nason; Ricardo A Rendon; Lori Wood; Robert A Huddart; Peter Albers; Lawrence H Einhorn; Craig R Nichols; Christian Kollmannsberger; Lynn Anson-Cartwright; Padraig Warde; Michael A S Jewett; Peter Chung; Philippe L Bedard; Aaron R Hansen; Robert J Hamilton Journal: Can Urol Assoc J Date: 2021-01 Impact factor: 1.862