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Keywords:

  • seminoma;
  • surveillance;
  • treatment;
  • burden;
  • stage 1;
  • radiation

Objective

  • To examine the management and outcomes of patients with stage I seminoma and to relate these to overall treatment burden.

Patients and Methods

  • A total of 764 patients with stage I seminoma underwent surveillance or adjuvant radiation therapy (RT) at a single institution.
  • First relapse on surveillance was managed with RT alone, or with combination chemotherapy (ChT) for more extensive recurrence. Second relapse was managed with ChT.
  • Relapse after adjuvant RT was treated with ChT.
  • The treatment burden was measured, according to the specific treatment undertaken after orchiectomy, by defining treatment episodes as follows: surgery – one episode; one course of RT – one episode; one course of ChT – one episode.

Results

  • In all, 484 patients underwent surveillance and 280 received adjuvant RT.
  • The 5- and 10-year overall survival rates were 98.6 and 97.7% for surveillance, and 97.2 and 91.4% for adjuvant RT.
  • A total of 72 (15%) patients in the surveillance group relapsed; treatment for relapse was RT (n = 56), ChT (n = 15) and surgery (n = 1). Second relapse occurred in six patients; these patients were treated with ChT.
  • Of the patients in the adjuvant RT group, 14 (5%) relapsed: salvage treatment was 10 – ChT (n = 10) surgery (n = 1) and further RT (n = 3).
  • The overall treatment burden represented by number of treatment episodes per patient was 0.16 in the surveillance group and 1.05 in the adjuvant RT group.

Conclusions

  • Surveillance reduces the overall treatment burden in patients with stage I seminoma and is the preferred management option.
  • The selective use of RT at first relapse for patients on surveillance leads to a similar requirement for subsequent ChT to that for patients on adjuvant RT.