Jorge Aparicio1, Alfonso Sánchez-Muñoz2, Josep Gumà3, Montserrat Domenech4, José A Meana5, José García-Sánchez6, Romà Bastús7, Regina Gironés8, Enrique González-Billalabeitia9, Naiara Sagastibelza10, Sebastián Ochenduszko11, Alfredo Sánchez12, Josefa Terrasa13, Josep R Germà-Lluch14, Xavier García Del Muro14. 1. Medical Oncology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. 2. Medical Oncology Department, Investigación Clínica y Traslacional en Cáncer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional y Virgen de la Victoria, Málaga, Spain. 3. Medical Oncology Department, Hospital Universitario Sant Joan, URV, IISPV, Reus, Spain. 4. Medical Oncology Department, Hospital Althaia, Manresa, Spain. 5. Medical Oncology Department, Hospital General, Alicante, Spain. 6. Medical Oncology Department, Hospital Arnau de Vilanova, Valencia, Spain. 7. Medical Oncology Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain. 8. Medical Oncology Department, Hospital Lluis Alcanyís, Xátiva, Spain. 9. Medical Oncology Department, Hospital Universitario Morales Meseguer-IMIB, UCAM, Murcia, Spain. 10. Medical Oncology Department, Hospital Donostia, San Sebastián, Spain. 11. Medical Oncology Department, Hospital Universitario Dr Peset, Valencia, Spain. 12. Medical Oncology Department, Hospital Provincial, Castellón, Spain. 13. Medical Oncology Department, Hospital Son Espases, Palma de Mallorca, Spain. 14. Medical Oncology Department, Institut Catalá d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, L'Hospitalet de Llobregat, Spain.
Abstract
OBJECTIVE: The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion. METHODS: Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22-60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method. RESULTS: After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%. CONCLUSION: A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.
OBJECTIVE: The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion. METHODS: Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22-60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method. RESULTS: After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%. CONCLUSION: A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.