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.