Roxanne Nelson

May 16, 2013

Surveillance should be the "preferred" management option for stage I seminoma patients, according to a new study. The long-term data show that the vast majority of men who opted for surveillance were alive 10 years after successful treatment for stage I seminoma.

"To our knowledge, this study is the largest to address this issue in patients with stage I seminoma, and it has the longest follow-up," said Mette Saksø Mortensen, MD, a PhD student from the Department of Oncology at the Copenhagen University Hospital in Denmark.

"Surveillance is a safe strategy for stage I seminoma patients, and 80% of these patients can avoid unnecessary adjuvant treatment after orchiectomy," Dr. Mortensen reported during a presscast held in advance of the 2013 Annual Meeting of the American Society of Clinical Oncology (ASCO).

The typical initial treatment for early-stage seminoma is orchiectomy, and regardless of the type of follow-up treatment (radiotherapy, carboplatin, or surveillance), the survival rates are excellent.

In their study, Dr. Mortensen and colleagues identified 4683 cases of germ cell cancers in a nationwide and population-based clinical database from 1984 to 2007. They were able to collect data on late relapses, vital status, and cause of death up to December 2012 for 1822 patients with stage I seminoma who were managed with surveillance.

"The surveillance program consisted of clinical visits, CT scans and/or x-rays, and measurement of tumor markers for a 5-year period," Dr. Mortensen explained. "The object of our study was to evaluate the Danish surveillance strategy in a nationwide cohort."

Median follow-up was 15.4 years, and 10-year cancer specific survival was 99.6%. In the study cohort, 355 (19.5%) patients relapsed after a median of 13.7 months — 72.4% within the first 2 years, 20.3% from year 2 to 5, and 7.3% after 5 years.

Seventy-two patients (4.0%) relapsed 2 to 5 years after orchiectomy, and 26 (1.4 %) relapsed more than 5 years after initial surgery.

Of the patients who relapsed, only 10 (0.55%) died from testicular cancer or a treatment-related cause, Dr. Mortensen reported.

On univariate and multivariate analyses, predictive factors for relapse included invasion of blood or lymphatic vessels, a tumor larger than 4 cm, and a serum human chorionic gonadotropin above 200 IU/L (P < .01). These factors had been associated with high-risk patients in previous smaller studies, she noted.

"Although long-term survival rates are excellent for this type of cancer, there has not been a standard postsurgical strategy," said ASCO president-elect Clifford A. Hudis, MD. "Many patients do receive adjuvant chemotherapy, radiation therapy, and surveillance."

"In this study, surveillance was safe, and in selected patients, neither chemotherapy nor radiation therapy was necessary," said Dr. Hudis, who comoderated the presscast. He noted that the survival data extrapolate to only 4 of 1000 patients dying of this cancer in a 10-year period.

"These data may encourage doctors and patients to opt for surveillance, and spare patients from additional therapy and complications," he added.

This research was supported in part by the Danish Cancer Society, the Danish Cancer Research Foundation, and the Preben and Anna Simonsen's Foundation. The authors have disclosed no relevant financial relationships.

2013 Annual Meeting of the American Society of Clinical Oncology. Abstract 4502. To be presented June 1, 2013.

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