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ASCO 2013: Surveillance Following Surgery Is Sufficient for Men with Stage I Seminoma

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Key Points

  • Researchers found that 99.6% of patients with stage I seminoma who underwent a surveillance program after being treated with surgery were alive 10 years after their initial diagnosis.
  • Of the 1,822 patients, 355 (19.5%) experienced a relapse, which was treated with radiotherapy (216 patients), chemotherapy (136 patients), or surgery (3 patients).
  • In the United States, about 50% of patients receive surveillance alone following surgery, but there has been a recent shift toward surveillance—a trend that will likely accelerate with these new data.

A long-term study of men with stage I seminoma, a common form of testicular cancer, suggests that surveillance for cancer recurrence, rather than additional chemotherapy or radiation therapy, is sufficient for the vast majority of men who have undergone successful surgery for their cancer. Researchers found that 99.6% of patients who underwent surveillance only were alive 10 years after their initial diagnosis. The study will be presented at the 2013 ASCO Annual Meeting in Chicago (Abstract 4502).

Surveillance entails 5 years of scheduled physical exams, chest x-ray exams, CT scans, and blood tests. In Denmark, where this study was conducted, surveillance is the follow-up strategy of choice. In the United States, about 50% of patients receive surveillance alone following surgery, while the remainder undergo either radiotherapy or chemotherapy (carboplatin). However, there has been a recent shift toward surveillance in the United States—a trend that will likely accelerate with these new data. Avoiding additional treatments spares patients of associated harmful side effects, such as a potential risk of secondary cancers, including gastrointestinal cancers and leukemia, following radiotherapy.

“To our knowledge, this study is the largest to address this issue in patients with stage I seminoma, and with the longest follow-up. Now we have solid proof that surveillance is safe and appropriate for most patients with this particular cancer,” said Mette Saksø Mortensen, MD, a PhD student in the Department of Oncology at the Copenhagen University Hospital in Copenhagen, Denmark. “We also characterized key prognostic factors for relapse, which can help us identify high-risk patients who may need adjuvant therapy instead of surveillance. However, in general, seminoma stage I patients can safely be followed on a surveillance program.”

Study Details

Using a nationwide clinical database, researchers identified 1,822 patients with stage I seminoma followed on a 5-year surveillance program in Denmark. By linking the patient files with national registries, they were able to follow the patients for a median period of 15.4 years. All patients had initial surgery to treat their primary cancer. Overall, 355 of 1,822 patients (19.5%) experienced a relapse, which was treated with radiotherapy (216 patients), chemotherapy (136 patients), or surgery (3 patients). The 10-year cancer-specific survival was 99.6%.

Researchers found that tumor size larger than 1.5 inches, spread to blood or lymphatic vessels, and elevated levels of human chorionic gonadotropin increased the risk of relapse. These factors had been associated with high-risk patients in prior, smaller studies.

ASCO President-Elect Clifford A. Hudis, MD, remarked, “This important study is one of several recent reminders that sometimes ‘less is more’ in patient care. Opting for surveillance spares patients, most of whom are young men, from the harmful side effects of chemotherapy and radiation without diminishing their chances for a long and healthy life.”

This research was supported in part by The Danish Cancer Society, The Danish Cancer Research Foundation, and the Preben and Anna Simonsen Foundation.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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