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ASCO 2013: Surveillance Sufficient Follow-up for Most Patients with Stage I Seminoma

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Key Points

  • In the largest and longest study of patients with stage I seminoma, surveillance appeared to be sufficient for almost all of the study population.
  • Factors associated with risk of relapse included tumor size, vascular invasion, and elevated levels of human chorionic gonadotropin.

Surveillance appears to be sufficient for men with stage I seminoma treated with orchiectomy, sparing patients from side effects of adjuvant radiation or chemotherapy. In a long-term study presented at the 2013 ASCO Annual Meeting (Abstract 4502), 99.5% of men followed by surveillance alone were disease-free and alive 15 years postdiagnosis.

The researchers identified prognostic factors associated with relapse, as well, which should help to identify high-risk patients who require a more intensive follow-up program.

Largest Stage I Seminoma Study

“To our knowledge, this is the largest study with the longest follow-up of surveillance for stage I seminoma ever performed. In this series, 80% of patients avoided unnecessary adjuvant treatment after orchiectomy, and only 19% relapsed. We believe surveillance is a safe strategy for stage I patients,” stated Mette Saksø Mortensen, MD, a PhD student from the Department of Oncology at Copenhagen University Hospital, Denmark.

Seminoma is a common form of testicular cancer, and approximately 80% of seminoma patients present with stage I. The primary treatment for stage I disease is orchiectomy. In many countries this is followed by adjuvant radiotherapy or adjuvant chemotherapy. Only a few countries offer surveillance instead of adjuvant treatments after orchiectomy.

The retrospective study included 1,822 men with stage I seminoma diagnosed between 1984 and 2008 and followed by a 5-year surveillance program after surgery. Surveillance was defined as 5 years of scheduled physical exams, chest x-ray exams, CT scans, and blood tests to measure tumor markers. Data from patients’ medical records were linked to national registries that recorded inpatient and outpatient clinic visits, relapses, and deaths.

Key Data

Median follow-up was 15.4 years (range, 0–28 years). Over that time, 355 relapses (19.5%) occurred; relapse was treated with radiotherapy in 216 patients, chemotherapy in 136 patients, and surgery in 3 patients. Only 10 patients (0.55%) died from testicular cancer or treatment-related causes.

Median time to relapse was 13.7 months (range, 1.2–173.3 months); 72.4% relapsed within the first 2 years, 20.3% within years 2 to 5, and 7.3% relapsed after 5 years of follow-up.

Prognostic factors associated with relapse were tumor size > 1.5 inches, invasion of blood or lymphatic vessels, and elevated levels of human chorionic gonadotropin. Dr. Mortensen said that these factors were also associated with a higher risk of relapse in previous smaller studies.

Reducing Harmful Side Effects

“These patients are mainly young men,” stated ASCO President Clifford A. Hudis, MD, commenting on the study. “For these selected patients, neither chemotherapy nor radiation therapy is necessary, sparing them from the harmful side effects of these treatments without diminishing their chances for a long and healthy life. With surveillance alone as a strategy, only 4 out of every 1,000 patients will die over a decade,” he noted.

“The study suggests that more treatment is probably not necessary for stage I seminoma patients. These data should encourage doctors and patients to opt for surveillance and avoid unnecessary treatment,” Dr. Hudis commented. 

Drs. Mortensen and Hudis reported no potential conflicts of interest.

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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