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Evidence-based guidelines for following stage 1 seminoma
Article first published online: 16 APR 2007
Copyright © 2007 American Cancer Society
Volume 109, Issue 11, pages 2248–2256, 1 June 2007
How to Cite
Martin, J. M., Panzarella, T., Zwahlen, D. R., Chung, P. and Warde, P. (2007), Evidence-based guidelines for following stage 1 seminoma. Cancer, 109: 2248–2256. doi: 10.1002/cncr.22674
- Issue published online: 18 MAY 2007
- Article first published online: 16 APR 2007
- Manuscript Accepted: 12 FEB 2007
- Manuscript Revised: 8 FEB 2007
- Manuscript Received: 9 JAN 2007
- evidenced-based guidelines;
- stage 1;
- testicular germ cell tumor
The authors developed evidence-based guidelines for a follow-up schedule after orchiectomy for stage 1 seminoma. Required investigations, frequency of assessment, overall duration of follow-up, and management strategies were identified.
A systematic review of the literature was performed of prospective studies in stage 1 seminoma. Studies published after 1980 were considered eligible for inclusion. Data extracted included relapse-free rates, number of patients at risk, and relapse locations. Five strategies were identified: Surveillance, Extended-Field Radiotherapy, Para-aortic Radiotherapy, and either 1 or 2 cycles of Carboplatin Chemotherapy. For each strategy, Kaplan-Meier relapse-free estimates were used to calculate weighted-mean cumulative hazards of relapse over time. These were used to calculate semiannual weighted-mean relapse hazards.
Seventeen prospective studies with a total of 5561 patients were identified. Actuarial data on relapse was available in 5013 (90.1%) patients, and 92.9% of all relapses had location data reported. Annual hazard rates for relapse were determined.
Evidence-based recommendations for follow-up frequency based on risk of relapse were formulated. The authors suggested 3 times per year when the risk is >5%, 2 times per year when the risk is 1% to 5%, and annually until the risk is <0.3%. Investigations should reflect location(s) at risk of relapse and include computed tomography of the abdomen and pelvis for surveillance and adjuvant carboplatin, whereas for para-aortic radiotherapy, pelvic computed tomography alone is required. These recommendations offer the possibility of maximal patient convenience and optimal healthcare resource allocation without compromising disease control. Cancer 2007. © 2007 American Cancer Society.