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Postsurgical surveillance sufficient for men with stage I seminoma
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Most men with stage I seminoma who undergo successful surgery for their cancer can be followed with surveillance, according to results of a long-term study in Denmark.
Researchers reported 10-year cancer-specific survival of 99.6% among men who underwent surgery for stage I seminoma — a common form of testicular cancer — and then underwent surveillance rather than follow-up chemotherapy or radiation.
“This is, to our knowledge, the largest study on surveillance for stage I seminoma that has ever been performed,” Mette Saksø Mortensen, MD, a PhD student in the department of oncology at Copenhagen University Hospital, said during a press conference intended to highlight select research that will be presented at the ASCO Annual Meeting. “We believe that surveillance is a safe strategy for [these] patients.”
Although testicular cancer is rare in the general population, seminoma accounts for about half of all cases in young men. About 4,000 cases of stage I seminoma are expected to be diagnosed in the United States this year, according to background information provided by researchers.
Half of all US patients who undergo surgery for stage I seminoma receive follow-up radiotherapy or chemotherapy. Surveillance is the preferred follow-up regimen in Denmark. That approach eliminates the risk of potential adverse effects — such as secondary malignancies — associated with radiotherapy.
Mortensen and colleagues conducted a study of 1,822 patients with stage I seminoma who underwent surgery between 1984 and 2008. After surgery, all patients underwent a 5-year surveillance program that included regular physical exams, chest X-rays, CT scans and blood tests.
Median follow-up was 15.4 years.
Overall, 355 patients (19.5%) experienced relapse. Of them, 216 patients were treated with radiotherapy, 136 underwent chemotherapy and three required additional surgery.
Median time to relapse was 30.7 months. Seventy-two percent of relapses occurred within the first 2 years after surgery, and 20.3% occurred within 2 to 5 years.
Ten patients died of testicular cancer or treatment-associated causes.
“We also characterized key prognostic factors for relapse, which can help us identify high-risk patients who may need adjuvant therapy instead of surveillance,” Mortensen said in a press release.
Those factors included tumor size larger than 1.5 inches, spread to lymphatic or blood vessels, and elevated levels of the hormone human chorionic gonadotropin.
For more information:
Mortensen MS. Abstract #4502. Scheduled for presentation at: ASCO Annual Meeting; May 31-June 4, 2013; Chicago.
Disclosure: The research was supported in part by The Danish Cancer Society, The Danish Cancer Research Foundation, and the Preben and Anna Simonsen Foundation.
Perspective
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Clifford A. Hudis, MD
Although long-term survival rates for this type of cancer are excellent, there actually has not been a standard post-surgery follow-up strategy. Many patients have received adjuvant chemotherapy and radiotherapy, and others have received surveillance. In this study, surveillance was safe. This suggests that, in these selected patients, neither chemotherapy nor radiation therapy is necessary. With the 10-year cancer-specific survival rate of 99.6%, this means that only four of every 1,000 patients will die of this cancer during a decade of follow-up. These results will encourage doctors and patients to opt for surveillance instead of treatment, [sparing] patients additional therapy and the associated effects.
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