Mortality After Cure of Testicular Seminoma

[dadmo]

This study looked at 453 seminoma patients treated with radiation at MD Anderson form the 1950's through the 1990's.

As with the other article, these authors also state in their paper that agressive treatment is responsible for the high success rate with TC.

One critical question that these papers don't address is whether TC patients are more likely to develop other cancers even if they have NO additional treatment.

I guess the bottom line is that we all have to be vigilant - many cancers are very treatable or even curable if detected at an early stage.

Mortality After Cure of Testicular Seminoma
Gunar K. Zagars, Matthew T. Ballo, Andrew K. Lee, and Sara S. Strom
ABSTRACT
Purpose: To determine the incidence of potentially treatment-related mortality in long-term survivors of testicular seminoma treated by orchiectomy and radiation therapy (XRT).
Patients and Methods: From all 477 men with stage I or II testicular seminoma treated at The University of Texas M.D. Anderson Cancer Center (Houston, TX) with postorchiectomy megavoltage XRT between 1951 and 1999, 453 never sustained relapse of their disease. Long-term survival for these 453 men was evaluated with the person-years method to determine the standardized mortality ratio (SMR). SMRs were calculated for all causes of death, cardiac deaths, and cancer deaths using standard US data for males.
Results: After a median follow-up of 13.3 years, the 10-, 20-, 30-, and 40-year actuarial survival rates were 93%, 79%, 59%, and 26%, respectively. The all-cause SMR over the entire observation interval was 1.59 (99% CI, 1.21 to 2.04). The SMR was not excessive for the first 15 years of follow-up: SMR, 1.30 (95% CI, 0.93 to 1.77); but beyond 15 years the SMR was 1.85 (99% CI, 1.30 to 2.55). The overall cardiac-specific SMR was 1.61 (95% CI, 1.21 to 2.24). The cardiac SMR was significantly elevated only beyond 15 years (P < .01). The overall cancer-specific SMR was 1.91 (99% CI, 1.14 to 2.98).
The cancer: SMR was also significant only after 15 years of follow-up (P < .01). An increased mortality was evident in patients treated with and without mediastinal XRT.
Conclusion: Long-term survivors of seminoma treated with postorchiectomy XRT are at significant excess risk of death as a result of cardiac disease or second cancer. Management strategies that minimize these risks but maintain the excellent hitherto observed cure rates need to be actively pursued.
J Clin Oncol 22:640-647. © 2004 by American Society of Clinical Oncology

This is the link to the full article:

http://www.jco.org/cgi/reprint/22/4/640

Recommended by Fish (Jim Trout)

[MRM]

I would hope the report notes that radiation today is much shorter and less intense (as well as more centralized) than what was administered in the early years of the study.

[Fish]

They discuss in detail the dosages of radiation and the sizes of the radiation fields used over the years. Their general feeling is that the lower the dosage and smaller the field, the less the risk of future problems. I personally think if this type of study is repeated in the future (say using data from 1985-2010). That the outcome will show less risk. Unfortunately since most of the complications do not appear to occur until 15+ years after the radiation treaments, it takes a long time to accumulate data.

Some of their more salient points - paraphrased.

1. For Stage I seminoma - a) more consideration should be given to surveillance;
b) consider a reduced radiation field and reduce dosage;
c) more studies to validate the efficacy of prophylactic chemotherapy agents.

2. For Stage II seminoma - recommended keeping treatments the same as the risk of death from seminoma is greater than risk of future problems.

3. Not explicitly stated, (my personal interpretation) - any who has had radiation therapy should be vigilant and have routine follow up exams for life, thus if any problems arise they can be addressed quickly and treated.
Of course routine exams are a good idea for everyone, not just cancer patients.