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Evidence-based guidelines for following stage 1 seminoma

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  • Evidence-based guidelines for following stage 1 seminoma

    Nice analysis of data culled from the literature that pulls together treatments, relapses, and suggested follow up schedules based upon relapse risk. Not enough data yet on 1 or 2 cycles of carboplatin, but the numbers so far look encouraging!! Full text available at:



    Cancer. 2007 Apr 16;

    Evidence-based guidelines for following stage 1 seminoma.

    Martin JM, Panzarella T, Zwahlen DR, Chung P, Warde P.

    Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.

    BACKGROUND.: The authors developed evidence-based guidelines for a follow-up schedule after orchiectomy for stage 1 seminoma. Required investigations, frequency of assessment, overall duration of follow-up, and management strategies were identified. METHODS.: A systematic review of the literature was performed of prospective studies in stage 1 seminoma. Studies published after 1980 were considered eligible for inclusion. Data extracted included relapse-free rates, number of patients at risk, and relapse locations. Five strategies were identified: Surveillance, Extended-Field Radiotherapy, Para-aortic Radiotherapy, and either 1 or 2 cycles of Carboplatin Chemotherapy. For each strategy, Kaplan-Meier relapse-free estimates were used to calculate weighted-mean cumulative hazards of relapse over time. These were used to calculate semiannual weighted-mean relapse hazards. RESULTS.: Seventeen prospective studies with a total of 5561 patients were identified. Actuarial data on relapse was available in 5013 (90.1%) patients, and 92.9% of all relapses had location data reported. Annual hazard rates for relapse were determined. CONCLUSIONS.: Evidence-based recommendations for follow-up frequency based on risk of relapse were formulated. The authors suggested 3 times per year when the risk is >5%, 2 times per year when the risk is 1% to 5%, and annually until the risk is <0.3%. Investigations should reflect location(s) at risk of relapse and include computed tomography of the abdomen and pelvis for surveillance and adjuvant carboplatin, whereas for para-aortic radiotherapy, pelvic computed tomography alone is required. These recommendations offer the possibility of maximal patient convenience and optimal healthcare resource allocation without compromising disease control. Cancer 2007. (c) 2007 American Cancer Society.
    Last edited by Karen; 04-19-07, 04:30 PM.
    Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

  • #2
    I read this paper, and it's a great find. I like that everything is synthesized really well and the results are quite consistent and in-line with current recommendations.
    "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
    11.22.06 -Dx the day before Thanksgiving
    12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

    Comment


    • #3
      Agreed. It's an elegant review of so many previous studies all in one handy paper! Anyone with early seminoma who has been treated, or is weighing pros and cons of treatment/surveillance, should give the full text a read. Even though I knew the areas of recurrance are different between para-aortic RT (PART) and dog-leg, it was amazing to look at the bar graph for recurrance location and timing. The tables and graphs say enough that you don't need to get your head spinning with the statistical analyses.
      Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

      Comment


      • #4
        I see the conclusions for the surveillance, the two dose carboplatin, and the RT for the para-aortic, but I don't see anything on the regimen/investigation area for the extended (hockey stick field to include pelvic nodes) RT therapy.

        CONCLUSIONS.: Evidence-based recommendations for follow-up frequency based on risk of relapse were formulated. The authors suggested 3 times per year when the risk is >5%, 2 times per year when the risk is 1% to 5%, and annually until the risk is <0.3%. Investigations should reflect location(s) at risk of relapse and include computed tomography of the abdomen and pelvis for surveillance and adjuvant carboplatin, whereas for para-aortic radiotherapy, pelvic computed tomography alone is required. These recommendations offer the possibility of maximal patient convenience and optimal healthcare resource allocation without compromising disease control.

        Am I just missing it? Thanks for the info.
        tlh
        diagnosed 28 June 06. Orchiectomy 29 June 06. Stage 1 Seminoma with no evidence of spread or Vasc invasion. Finished adjuvant RT (27Gy) to abdominal and pelvic area August 28th, 2006.

        Comment


        • #5
          Originally posted by tlh
          I see the conclusions for the surveillance, the two dose carboplatin, and the RT for the para-aortic, but I don't see anything on the regimen/investigation area for the extended (hockey stick field to include pelvic nodes) RT therapy.

          Am I just missing it? Thanks for the info.
          thl,
          If you go to the full test article you'll see a lot of information on extended field RT. The abstract on this paper doesn't do justice to all the information the full text contains.
          Karen
          Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

          Comment


          • #6
            Karen,

            Is there a way around the $25.00 registration fee to view the whole article or is registering for access the only way? It's not a big deal, just want to be sure before I pay to register. Thanks.
            tlh
            diagnosed 28 June 06. Orchiectomy 29 June 06. Stage 1 Seminoma with no evidence of spread or Vasc invasion. Finished adjuvant RT (27Gy) to abdominal and pelvic area August 28th, 2006.

            Comment


            • #7
              Sorry all, I guess I have access through my employer and didn't realize it.

              tlh,
              I sent you a PM
              Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

              Comment


              • #8
                Also, the article is still on "EarlyView", so they don't have the PDF version, yet.
                "Life moves pretty fast; if you don't stop and look around once in a while, you could miss it." -Ferris Bueller
                11.22.06 -Dx the day before Thanksgiving
                12.09.06 -Rt I/O; 100% seminoma, multifocal; Stage I-A; Surveillance; Six years out! I consider myself cured.

                Comment


                • #9
                  Folks:

                  My employer doesn't subscribe to this journal, so I emailed the corresponding author requesting a reprint and received a copy in just a few days. Most researchers are happy to provide copies of their publications.

                  Karen's right the paper is much better that you would think from reading the abstract.
                  Fish
                  TC1
                  Right I/O 4/22/1988
                  RPLND 6/20/1988
                  TC2
                  Left I/O 9/17/2003
                  Surveillance

                  Tho' much is taken, much abides; and though we are not now that strength which in old days moved earth and heaven; that which we are, we are; one equal temper of heroic hearts, made weak by time and fate, but strong in will; to strive, to seek, to find, and not to yield.

                  Comment


                  • #10
                    OK, any idea now where to get full article for free ? Thanx.
                    Seminoma I. stage ,May 2004,Si Deus pro nobis quis contra nos

                    Comment


                    • #11
                      Krokar,
                      As Fish mentioned, e-mail the corresponding author and request a reprint. Whenever scientists publish they generally receive a set numner of reprints of their article for distribution to those that request it.

                      I thought this article was a must read for all the seminoma guys.

                      email: Padraig Warde ([email protected])
                      *Correspondence to Padraig Warde, Department of Radiation Oncology, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada
                      Fax: (416) 946-4568
                      Retired moderator. Husband, left I/O 16Dec2005, stage I seminoma with elevated b-HCG, no LVI, RTx15 (25Gy). All clear ever since.

                      Comment


                      • #12
                        Being a seminoma survivor, I was very interested in reading this. It is a good summary and had some information I had not seen in my prior research. It was very interested to see the differences between the different treatment types.

                        What caught my eye was the difference in recurrence frequency / timing between the para-aortic and the extended pattern RT. Definitely counters what my oncologist told me at my last visit: that almost all recurrences happen in the first 18 months. Seems to me that he is confused either as to the type of TC I had or the treatment I took - but in any case, this article is a good summary to have in my back pocket for my next follow-up visit.

                        As the TCRC site says: Most nonseminoma recurrences occur within the first two years after treatment. Most seminoma recurrences happen within the first five years after treatment. However, in all TC cases, the cancer can occasionally come back much later. It may not be reasonable to follow a surveillance protocol for the next 40 years, but you should do your best to keep in contact with your doctor yearly, and you should always be sure that your current doctor knows that you had testicular cancer way back when. If your doctor says you are cured and done after 2 years, don't believe it.
                        Right I/O 4/17/06, Seminoma Stage Ib
                        RT (15 days) completed 6/1/06
                        All clear as of 5/8/09

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