Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma

Abstract

Treatment options in patients with stage I seminoma include radiotherapy (RT), surveillance, and adjuvant chemotherapy. This patient population has virtually a 100% cure rate whichever approach is taken. While adjuvant retroperitoneal RT has been the standard of care for the past 50-60 years, there is increasingly persuasive data that adjuvant RT in this setting is associated with a small but definite increased risk of second malignancy and cardiovascular death. The long-term data from surveillance series have documented the safety of this approach, and it is now accepted that a policy of surveillance is the optimal management approach. This gives a relapse rate of 15%, and most patients can be successfully salvaged with RT. Second relapse after salvage RT occurs in a small proportion of cases, and these patients are cured with chemotherapy. Adjuvant chemotherapy using carboplatin has been investigated as an alternative strategy but has not lived up to its initial promise. If used, then 2 courses of treatment should probably be given. It must be remembered that 80-85% of patients with testicular seminoma require no treatment after orchiectomy, and the long-term side effects of any adjuvant treatment approach must be carefully considered.

Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma

“…These include surveillance, a policy that reserves further treatment for those who relapse, or the use of adjuvant chemotherapy rather than radiotherapy. With surveillance in unselected patients about 15–20% will have recurrent disease, very predominantly in para-aortic lymph nodes, and virtually all recurrences are treated successfully (Warde et al , 2002; Daugaard et al , 2003; Martin et al , 2006; Cummins et al , 2010). Single-agent carboplatin has been evaluated as adjuvant treatment postorchidectomy.…”

Update on management of seminoma

“…[12] It is the most common presentation of testicular cancer. Stage I seminoma had been managed with orchidectomy and adjuvant radiotherapy as the mainstay of treatment for over 50 years.…”

Is Radiotherapy a Good Adjuvant Strategy for Men With a History of Cryptorchism and Stage I Seminoma?

“…Stage I seminoma is the most common testicular cancer diagnosis (1). After high inguinal orchiectomy, men are treated with surveillance, adjuvant radiotherapy (RT), or carboplatin chemotherapy.…”