Alberto Diminutto1, Umberto Basso2, Marco Maruzzo1, Franco Morelli3, Ugo De Giorgi4, Alessandra Perin5, Anna Paola Fraccon6, Giovanni Lo Re7, Anna Rizzi8, Teodoro Sava9, Giuseppe Fornarini10, Francesca Valcamonico11, Fable Zustovich1, Francesco Massari9, Elisa Zanardi1, Anna Roma1, Filiberto Zattoni12, Vittorina Zagonel1. 1. Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy. 2. Istituto Oncologico Veneto IOV IRCCS, Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Padova, Italy. Electronic address: umberto.basso@ioveneto.it. 3. Casa Sollievo della Sofferenza IRCCS, Medical Oncology Department, Foggia, Italy. 4. IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (I.R.S.T.), Medical Oncology Department, Forlì-Cesena, Italy. 5. Azienda ULSS 4 Alto Vicentino, Medical Oncology Department, Vicenza, Italy. 6. Casa di Cura Polispecialistica Dott. Pederzoli, Medical Oncology Department, Verona, Italy. 7. Ospedale Santa Maria Degli Angeli, Medical Oncology Department, Pordenone, Italy. 8. Fondazione Poliambulanza - Istituto Ospedaliero, Medical Oncology Department, Brescia, Italy. 9. Azienda Ospedaliera Universitaria Integrata Verona, Medical Oncology Department, Verona, Italy. 10. IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Medical Oncology Department, Genova, Italy. 11. Spedali Civili di Brescia, Medical Oncology Department, Brescia, Italy. 12. Urology Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, Padova, Italy.
Abstract
BACKGROUND: The administration of carboplatin AUC 7 has become a standard adjuvant option for patients undergoing orchiectomy for stage I seminoma, in alternative to radiotherapy on retroperitoneal lymphnodes or surveillance. The toxicity of AUC 7 carboplatin appeared manageable in the pivotal trial of Oliver et al, but dose ranges were not reported. Fear of toxicity may induce arbitrary dose reductions, which may potentially compromise patients' outcome. PATIENTS AND METHODS: We reviewed adjuvant carboplatin administration in 115 stage I seminoma patients followed in 11 Italian medical oncology centers since 2005. Clinical and pathological data, modality of carboplatin dose calculation, dose reductions, toxicities, and relapses were recorded. RESULTS: Median age was 35 years (range, 18-65 years), adverse prognostic factors were either T ≥ 4 cm (17.4%) or rete testis invasion (28.7%), both of them (35.7%), none or unspecified (18.3%). GFR was estimated mainly by Cockroft-Gault formula (55.7%) or Jeliffe formula (26.1%), with a median of 105 mL/min (range, 75-209 mL/min). The median dose of carboplatin was 900 mg (range, 690-1535 mg). A dose reduction > 10% was applied to 14 patients. Toxicities were mild fatigue, moderate nausea/vomiting, 5.2% of grade 3 to 4 thrombocytopenia. After a median follow-up of 22.1 months, 5.2% of patients have relapsed in the retroperitoneal lymph nodes. None of the patients that relapsed were treated with reduced dose. All but one achieved complete remission with salvage chemotherapy. CONCLUSIONS: Adjuvant AUC 7 carboplatin reduce relapses of stage I seminoma patients to 5.2%, with manageable toxicities. Dose reductions should be proscribed.
BACKGROUND: The administration of carboplatin AUC 7 has become a standard adjuvant option for patients undergoing orchiectomy for stage I seminoma, in alternative to radiotherapy on retroperitoneal lymphnodes or surveillance. The toxicity of AUC 7 carboplatin appeared manageable in the pivotal trial of Oliver et al, but dose ranges were not reported. Fear of toxicity may induce arbitrary dose reductions, which may potentially compromise patients' outcome. PATIENTS AND METHODS: We reviewed adjuvant carboplatin administration in 115 stage I seminomapatients followed in 11 Italian medical oncology centers since 2005. Clinical and pathological data, modality of carboplatin dose calculation, dose reductions, toxicities, and relapses were recorded. RESULTS: Median age was 35 years (range, 18-65 years), adverse prognostic factors were either T ≥ 4 cm (17.4%) or rete testis invasion (28.7%), both of them (35.7%), none or unspecified (18.3%). GFR was estimated mainly by Cockroft-Gault formula (55.7%) or Jeliffe formula (26.1%), with a median of 105 mL/min (range, 75-209 mL/min). The median dose of carboplatin was 900 mg (range, 690-1535 mg). A dose reduction > 10% was applied to 14 patients. Toxicities were mild fatigue, moderate nausea/vomiting, 5.2% of grade 3 to 4 thrombocytopenia. After a median follow-up of 22.1 months, 5.2% of patients have relapsed in the retroperitoneal lymph nodes. None of the patients that relapsed were treated with reduced dose. All but one achieved complete remission with salvage chemotherapy. CONCLUSIONS: Adjuvant AUC 7 carboplatin reduce relapses of stage I seminomapatients to 5.2%, with manageable toxicities. Dose reductions should be proscribed.
Authors: Christian G Ruf; Stefanie Schmidt; Sabine Kliesch; Christoph Oing; David Pfister; Jonas Busch; Julia Heinzelbecker; Christian Winter; Friedemann Zengerling; Peter Albers; Karin Oechsle; Susanne Krege; Julia Lackner; Klaus-Peter Dieckmann Journal: World J Urol Date: 2022-09-15 Impact factor: 3.661