A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study

Aparicio, Jorge; Sánchez-Muñoz, Alfonso; Gumà, Josep; Domènech, Montserrat; Meana, J. A.; García-Sánchez, José; Bastús, R.; Gironés, Regina; González-Billalabeitia, Enrique; Sagastibelza, N.; Ochenduszko, Sebastián; Sánchez, Alfredo; Terrasa, Josefa; Germá-Lluch, J. R.; Muro, Xavier García del

doi:10.1159/000487438

Cited by 12 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The question arises whether the use of carboplatin is justified, having in mind modest benefit over AS in CSI seminoma patients. Similar conclusions could be drawn from several other studies, indicating that additional investigations are warranted to further evaluate the carbplatin role in the contemporary management of CSI [13,[72][73][74][75][76].…”

Section: Adjuvant Chemotherapysupporting

confidence: 84%

“…In conclusion, 67% of patients did not receive adjuvant chemotherapy and majority of high-risk cases avoided disease recurrence. Apart from previous study, the fourth one by the Spanish Germ Cell Cancer Group maintained the same design and only included the existence of rete testis invasion as a predictive factor of a poorer outcome [75]. Invasion of rete testis was present in 47.4% of 135 CSI seminoma patients, and they received adjuvant carboplatin.…”

Section: Orchiectomy Tissue Specimensmentioning

confidence: 99%

See 1 more Smart Citation

Treatment options in stage I seminoma

BUMBASIREVIC¹,

Zivkovic²,

Petrovic³

et al. 2022

Oncology Research

View full text Add to dashboard Cite

Seminomas are most commonly diagnosed in clinical stage I (CSI). After orchiectomy, approximately 15% of patients in this stage have subclinical metastases. Adjuvant radiotherapy (ART) delivered to the retroperitoneum and ipsilateral pelvic lymph nodes has been the mainstay of treatment for many years. Although highly efficient, with long-term cancer-specific survival (CSS) rates approaching almost 100%, ART is associated with considerable longterm consequences, particularly cardiovascular toxicity and increased risk of secondary malignancies (SMN).Therefore, active surveillance (AS) and adjuvant chemotherapy (ACT) were developed as alternative treatment options. While AS prevents patient overtreatment, it is associated with strict follow-up regimens and increased radiation exposure due to repeated imaging. Due to equivalent CSS rates to ART, and lower toxicity, one course of adjuvant carboplatin presents the cornerstone of chemotherapy for CSI patients. CSS is almost 100% for patients with CSI seminoma, regardless of the chosen treatment option. Therefore, a personalized approach in treatment selection is preferred. Currently, routine radiotherapy for CSI seminoma patients is no longer recommended. Instead, it should be reserved for patients who are unfit or unwilling for AS or ACT. Identification of prognostic factors for disease relapse allowed for the development of risk-adapted treatment strategy and stratification of patients in low-risk and high-risk groups. Although risk-adapted policy needs further validation, surveillance is currently recommended in low-risk patients, while ACT is reserved for patients with a higher risk of relapse.

show abstract

Section: Adjuvant Chemotherapysupporting

confidence: 84%

Section: Orchiectomy Tissue Specimensmentioning

confidence: 99%

Treatment options in stage I seminoma

BUMBASIREVIC¹,

Zivkovic²,

Petrovic³

et al. 2022

Oncology Research

View full text Add to dashboard Cite

show abstract

“…Risk‐based management is proposed by some studies 18 , 19 , 20 , 21 and guidelines, 22 reserving adjuvant carboplatin for patients with one or both of rete testis involvement (RTI) or tumor size more than 4 cm. However, significant heterogeneity in the predictive value of these risk factors questions the reliability of this approach.…”

Section: Introductionmentioning

confidence: 99%

Two cycles of adjuvant carboplatin for clinical stage 1 testicular seminoma in New Zealand centres: A retrospective analysis of efficacy and long‐term events

et al. 2020

View full text Add to dashboard Cite

Background Adjuvant carboplatin reduces relapse risk in clinical stage 1 (CS1) seminoma, though there is a paucity of long‐term safety data. Aim Our objective was to report long‐term outcomes of two cycles of adjuvant carboplatin dosed at area under the time–concentration curve (AUC) of 7. Methods and results We performed a retrospective analysis on treatment and outcomes of patients with CS1 seminoma who received adjuvant carboplatin from 2000 to 2016 at our centres in the Midland Region, New Zealand. Of 159 patients, median age 39 years, 153 received two cycles of carboplatin: 147 dosed at AUC7 and 6 at AUC6. Six patients had one cycle of carboplatin AUC7. One patient relapsed at 22 months and died of bleomycin pneumonitis 2 months after achieving a complete response with BEP chemotherapy. Neither RTI (present in 21.3%) nor tumor size >4 cm (in 43.3%) was predictive of relapse. Median follow‐up was 106 months. At 15 years, outcomes were: relapse‐free survival 99.4%, overall survival 91.4%, disease‐specific survival 100%, subsequent malignant neoplasm rate 7.6%, and second testicular germ cell tumor rate 3.85%. One patient had persistent grade 1 thrombocytopenia at 46 months. Conclusions These data add to the body of evidence that two cycles of carboplatin AUC7 is safe and effective adjuvant treatment for CS1 seminoma.

show abstract

“…A risk-adapted approach seams feasible and showed that absence of both risk factors predicted an excellent outcome with a 3-year disease free survival of 94.9% [20].…”

mentioning

confidence: 99%

Stage I testicular seminoma risk-adapted therapeutic management

Mrinakova

Kajo

Lehotská

et al. 2021

neo

View full text Add to dashboard Cite

Following orchiectomy, patients with clinical stage I (CSI) testicular seminoma may be managed by active surveillance (S) or adjuvant treatment (radiotherapy or chemotherapy). In view of the published data on long-term toxicity, especially second malignant neoplasms (SMNs), adjuvant radiotherapy (ART) is currently no longer recommended as an adjuvant therapy option for these patients. The purpose of our recent study was to compare the impact of two selected treatment approaches-S versus adjuvant chemotherapy (ACT) on the survival of patients with CSI testicular seminoma. This cross-sectional study analyzed a total of 139 patients collected at a single center between 10/2011-5/2020, with CSI testicular seminoma, stratified into two groups according to risk-adapted therapeutic approaches. In the S group (low-risk-without rete testis invasion-RTI, primary tumor size < 4 cm), consisting of 77 patients, who underwent S, relapse occurred in 10 (13.0%) patients after a mean follow-up of 14.3 months. In the ACT group (high-risk-RTI and/or primary tumor size > 4 cm), consisting of 62 patients, who were treated with ACT, relapse occurred in 5 (8.1%) patients after a mean follow-up of 11.6 months. Overall survival of patients in both groups was 100% with a mean follow-up of 43.9 months. A statistically significant difference in progression-free survival (PFS) between these two groups was not found. Based on our findings, ACT seems to be an adequate treatment for patients with a high-risk of relapse, as well as S for those with a low-risk of relapse. Despite its excellent prognosis, optimal management of CSI testicular seminoma remains controversial, with variations in expert opinion and international guidelines.

show abstract

A Risk-Adapted Approach to Patients with Stage I Seminoma according to the Status of Rete Testis: The Fourth Spanish Germ Cell Cancer Group Study

Cited by 12 publications

References 16 publications

Treatment options in stage I seminoma

Treatment options in stage I seminoma

Two cycles of adjuvant carboplatin for clinical stage 1 testicular seminoma in New Zealand centres: A retrospective analysis of efficacy and long‐term events

Stage I testicular seminoma risk-adapted therapeutic management

Contact Info

Product

Resources

About