Adjuvant Carboplatin or Active Surveillance After Surgery for Early-Stage Seminoma?

According to a study published in Oncology on 15 April 2016, patients with early-stage seminoma (testicular cancer) at low risk of postoperative recurrence may receive drug-free active surveillance instead of adjuvant chemotherapy.

Although rare, testicular cancer is the most common cancer type in men aged 15-35. Most (more than 90%) develop in sperm-producing cells known as germ cells. There are two germ cell tumor types:

• Seminoma
• Nonseminoma

Cells of these two types look very different under the microscope and their treatment approaches differ.

More than 95% of seminomas are called classic seminoma, most common in men aged 25-45.

Through this link, symptoms of testicular cancercan be read.

Testicular cancer treatment depends on type (seminoma, nonseminoma and mixed germ cell tumors) and stage.

Standard treatment for stage-1 (early-stage) seminoma is surgery called orchiectomy followed by adjuvant chemotherapy. Because recurrence likelihood is known to be low, the necessity of preventive chemotherapy has long been questioned. The study discussed here appears to provide important answers. This multicenter, prospective study included clinically stage-1 seminoma (early-stage testicular tumor) in 897 patients.

Active enrollment occurred between 2007-2010; patients were followed for a median of 5.6 years. Of them, 469 received a single dose of carboplatin chemotherapy, while 422 underwent drug-free active surveillance.

Invasion of the region called the rete testis by cancer cells and tumor diameter greater than 4 cm were identified as indicators of recurrence (relapse), called “risk factors indicating relapse.”

In patients without risk factors, recurrence rates were 4% in the untreated surveillance group versus 2,2% with single-dose adjuvant carboplatin. In patients with one or two risk factors, relapse rates were 15,5% under untreated surveillance and 9,3% with chemotherapy.

In conclusion, patients with early-stage (clinical stage-1) seminoma without risk factors do not significantly benefit from carboplatin, the standard postoperative adjuvant chemotherapy, and have lower relapse likelihood.