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Article and 2 editorials on carboplatin for stage 1 seminoma

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  • Article and 2 editorials on carboplatin for stage 1 seminoma

    Risk-Adapted Management for Patients With Clinical Stage I Seminoma: The Second Spanish Germ Cell Cancer Cooperative Group Study. Journal of Clinical Oncology, Vol 23, No 34 (December 1), 2005: pp. 8717-8723
    Jorge Aparicio et. al.

    PATIENTS AND METHODS: Between 1999 and 2003, 314 patients with clinical stage I seminoma after orchiectomy were prospectively included. One hundred patients (31.8%) presented no risk factors and were managed with surveillance. In contrast, 131 patients (41.7%) had tumors larger than 4 cm, 33 patients (10.5%) had rete testis involvement, and 50 patients (15.9%) had both risk factors. All the latter received two courses of adjuvant carboplatin.

    RESULTS: Chemotherapy was well tolerated, as only 17 patients (7.9%) presented grade 3 to 4 toxicity. Relapses were observed in six patients (6.0%) on surveillance and in seven patients (3.3%) treated with carboplatin (0.8% of tumors larger than 4 cm, 9.1% of those involving the rete testis, and 6.0% of patients with both risk criteria). All were located at the retroperitoneum, except for one at the spermatic cord. Median tumor size was 25 mm (range, 11 to 70 mm), and median time to relapse was 9 months (range, 4 to 28 months). All patients were rendered disease-free with chemotherapy (etoposide plus cisplatin). Median follow-up was 34 months (range, 12 to 72 months). The actuarial 5-year disease-free survival rate was 93.4% for patients on surveillance and 96.2% for patients treated with adjuvant chemotherapy. Overall 5-year survival was 100%.

    CONCLUSION: Adjuvant carboplatin is effective in reducing the relapse rate in patients with stage I seminoma and risk factors. A risk-adapted strategy is safe and feasible and should be considered an alternative to systematic approaches, such as irradiation, chemotherapy, or surveillance.

    Carboplatin for Stage I Seminoma and the Sword of Damocles. Journal of Clinical Oncology, Vol 23, No 34 (December 1), 2005: pp. 8566-8569.
    Patrick J. Loehrer, Sr

    The Sword of Damocles and the Treatment of Stage I Seminoma
    Tim Oliver et. al. J Clin Oncol. 2006 Jun 1;24(16):2599-600.
    Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.