T Tandstad1, O Ståhl2, O Dahl3, H S Haugnes4, U Håkansson5, Å Karlsdottir6, A Kjellman7, C W Langberg8, A Laurell9, J Oldenburg10, A Solberg11, K Söderström12, U Stierner13, E Cavallin-Ståhl2, R Wahlqvist14, N Wall15, G Cohn-Cedermark16. 1. The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway torgrim.tandstad@stolav.no. 2. Department of Oncology, Skane University Hospital, Lund, Sweden. 3. Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen Department of Oncology, Haukeland University Hospital, Bergen. 4. Institute of Clinical Medicine, University of Tromsø, Tromsø Department of Oncology, University Hospital of North Norway, Tromsø, Norway. 5. Department of Urology, Skåne University Hospital, Malmö 6. Department of Oncology, Haukeland University Hospital, Bergen. 7. Division of Urology, Karolinska University Hospital, Stockholm, Sweden. 8. Department of Oncology, Oslo University Hospital, Oslo, Norway. 9. Uppsala University Hospital, Uppsala, Sweden. 10. Department of Oncology, Akershus University Hospital, Lørenskog Faculty of Medicine, University of Oslo, Oslo, Norway. 11. The Cancer Clinic, St Olavs University Hospital, Trondheim, Norway. 12. Norrland University Hospital, Umeå 13. Department of Oncology, Sahlgrenska University Hospital, Gothenburg Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden. 14. Department of Urology, Oslo University Hospital, Oslo, Norway. 15. Institute of Clinical and Experimental Medicine, University of Linköping, Linköping Department of Oncology, Linköping University Hospital, Linköping. 16. Department of Oncology-Pathology, Karolinska Institute, Stockholm Karolinska University Hospital, Stockholm, Sweden.
Abstract
BACKGROUND: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter >4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. PATIENTS AND METHODS: From 2007 to 2010, 897 patients were included in a prospective, population-based, risk-adapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n = 469) or surveillance (n = 422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. RESULTS: At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis [hazard ratio (HR) 1.9, P = 0.011] and tumor diameter >4 cm (HR 2.7, P < 0.001) were identified as risk factors predicting relapse. In patients without risk factors, the relapse rate (RR) was 4.0% for patients managed by surveillance and 2.2% in patients receiving adjuvant carboplatin. In patients with one or two risk factors, the RR was 15.5% in patients managed by surveillance and 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin <7 × AUC compared with that in patients receiving ≥7 × AUC. CONCLUSION: Stromal invasion in the rete testis and tumor diameter >4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.
BACKGROUND: The purpose of the protocol was to reduce the treatment burden in clinical stage I (CSI) seminoma by offering risk-adapted treatment. The protocol aimed to prospectively validate the proposed risk factors for relapse, stromal invasion of the rete testis and tumor diameter >4 cm, and to evaluate the efficacy of one course of adjuvant carboplatin. PATIENTS AND METHODS: From 2007 to 2010, 897 patients were included in a prospective, population-based, risk-adapted treatment protocol implementing one course of adjuvant carboplatin AUC7 (n = 469) or surveillance (n = 422). In addition, results from 221 patients receiving carboplatin between 2004 and 2007 are reported. RESULTS: At a median follow-up of 5.6 years, 69 relapses have occurred. Stromal invasion of the rete testis [hazard ratio (HR) 1.9, P = 0.011] and tumor diameter >4 cm (HR 2.7, P < 0.001) were identified as risk factors predicting relapse. In patients without risk factors, the relapse rate (RR) was 4.0% for patients managed by surveillance and 2.2% in patients receiving adjuvant carboplatin. In patients with one or two risk factors, the RR was 15.5% in patients managed by surveillance and 9.3% in patients receiving adjuvant carboplatin. We found no increased RR in patients receiving carboplatin <7 × AUC compared with that in patients receiving ≥7 × AUC. CONCLUSION: Stromal invasion in the rete testis and tumor diameter >4 cm are risk factors for relapse in CSI seminoma. Patients without risk factors have a low RR and adjuvant therapy is not justified in these patients. The efficacy of adjuvant carboplatin is relatively low and there is need to explore more effective adjuvant treatment options in patients with high-risk seminoma. The data do not support the concept of a steep dose response for adjuvant carboplatin.
Authors: Rune A W van de Wetering; Stefan Sleijfer; Darren R Feldman; Samuel A Funt; George J Bosl; Ronald de Wit Journal: J Clin Oncol Date: 2018-02-01 Impact factor: 44.544
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