Question

[amirla80]

i had my surgery to remove the Left testicle about 4 weeks ago. (i had a pure seminoma). i just went to my radiation oncologist today and he told me that i can either do radiation for 3 weeks or go with Chemotherapy.
now im alittle confused because i thought for this type of cancer the only treatment is either radiation or Surveillance. im gonna go see a medical oncologist next week to get a second opinion.
what do you guys think?

[Scott]

i just went to my radiation oncologist today and he told me that i can either do radiation for 3 weeks or go with Chemotherapy.
now im alittle confused because i thought for this type of cancer the only treatment is either radiation or Surveillance.

I assume he was talking about single agent carboplatin, which was promoted to category 2B (non-uniform consensus but no major disagreement) in the most recent NCCN guidelines. Sufficient data isn't available yet on long-term effectiveness and late side effects, and whether having been treated with carboplatin changes the effectiveness of cisplatin if needed later in case of relapse.

[Fed]

On my first appointment with my oncologist, we discussed all of the options for follow-up including adjuvant chemo (which is two shots of carboplatin). He said that the only situation in which he would consider using adjuvant chemo for stage I seminoma would be if the pathological stage of the primary tumor was at least pT2 (lymphovascular invasion present). I should note that at Dana-Farber there is a tendency to consider novel trends in treatment. Case in point, I was refused adjuvant radiation with pT1; I wasn't pleased at first, but I am not regretting my decision to go on surveillance.

[Already Bald]

I wasn't pleased at first,

Brother Fed, could you elaborate please?

Amirla80- This is just my opinion, but I think chemo should be avoided if possible. It's short and long term side effects can be vast- however it will be there if needed for further treatment.

And I'll elaborate a little:
When I spoke to the urologist that preformed my I/O, after he received the pathology, my CT showed a lung nodule. I knew very little about TC- and he suggested to me the options are:
1. Check the nodes (RPLND)
2. 2 cycles of chemo.

I immediatly wanted to start the chemo, afraid of the RPLND. Then I started to read on this site, and other sites- and I went for the RPLND.
Then I needed the Chemo, and it was there for me.

(The original lung nodule is and has been stable.)

[Lisa&Joe]

Hi Amirla

My husband also was dx with pure Stage 1 seminoma. He goes to Memorial Sloan Kettering. They did not recommend chemo. Neither did the oncologist we saw at Columbia Presbyterian. Just surveillance vs radiation. We chose radiation and he just finished last Friday.

Most important piece of advise I can tell you is to get a second and even third opinion. Everyone's case is different.

[Krokar]

..., and whether having been treated with carboplatin changes the effectiveness of cisplatin if needed later in case of relapse.

There were many topics about Carboplatin since 2004 when I was treated with this chemo in Europe.While in 2004 all forum members were against this, many clinics in USA today use Carboplatin also like possible treatement like described in NCCN guidelines. Carboplatin is not new drug it is used for years for colone cancer... and it is no so "unknown" about side effects. Certanly it is not true that there is any evidence about problems cisplatin treatement after Carboplatin when Carboplatin was used for TC cancer... but like I found out in last years... no use to explain this so many times.

[Fed]

Brother Fed, could you elaborate please?

I thought I had already replied to this, but I guess my mind was elsewhere at the time. Sorry for the delayed response. I wrote extensively about this on one of my very first authored threads. Part of the reason I was upset had to do with the nonchalance of my first treatment team, but the other half was due to the suddenly forced change in mindset. I was adamant about getting XRT because I wanted the best odds in beating this for good, and the refusal of two DFCI doctors to even consider the adjuvant therapy in my case was frustrating, especially after my urologist had recommended it. I guess it was mostly due to the overwhelming amount of information I needed to digest so quickly after the I/O. I am satisfied with my decision to go on surveillance with the knowledge that if the beast comes back, I can still beat it back with other weapons in the arsenal.

Certanly it is not true that there is any evidence about problems cisplatin treatement after Carboplatin when Carboplatin was used for TC cancer... but like I found out in last years... no use to explain this so many times.

...which actually brings me to the point of other weapons in the arsenal. When I met my current oncololgist, I brought up the possibility of using carboplatin as adjuvant chemo. Like I have said before, he would only recommend it in cases of stage I-B seminoma (pT2 or pT3). It seems to me, and I could be wrong, that the trend is to move away from XRT. True, there are very few studies that evaluate the long-term effects of adjuvant carboplatin used for the treatment of stage I seminoma, and the issue of the development of cross-resistance with cisplatin is a valid concern. This is something that is very difficult to predict without further studies. It is evident to me, though, that adjuvant carboplatin is gaining traction as a possible alternative to adjuvant radiation (as exemplified by the 2008 version of the NCCN Guidelines). Speaking in the short term, there's a difference in acute side effects between having radiation treatments every 5 days for three weeks vs. two shots (or infusions, I don't know the route of administration) of carbo. The possible long-term effects of XRT used in TC treatment are known, but not so for carbo -they may be known for other cancers, but certainly not for TC. If I am mistaken in this assessment, by all means point me to where I can find such information.

[dadmo]

Here's some info on carboplatin from chemocare .

[TimsWife]

Tim did Carboplatin 2x for Stage 1 Seminoma 18 months ago. If you have any questions, please ask!

[TimsWife]

Hi Paul,

Tims Wife:
Sorry I don't know your name. (It is Kelly)

I read your last post on this topic back on 9-11-07. Any regrets? Any other side effects? Were side effects bad enough to interfer with work? Was gaining 10 pounds desired or not? Has the oncologist expressed any regrets? Did you medical insurance cover this or excluded due to "experimental" status (I have UnitedHealth Care and haven't asked.)

Thanks,
Paul

Any regrets?- Not so far. We were REALLY concerned about trading a cancer like Testicular cancer which is VERY curable for a not-so-curable cancer later in life. I know it sounds like a funny way to process this, but they way it came about was this- Originally Tim was presented with Survelliance or Radiation. Tim said he absolutely would not do radiation and I do not have the nerves to cope with Survelliance so we looked for another option, hence Carboplatin 2x. I did a ton of research, spoke to people all over the world who have done this treatment and we made our choice.

Side effects- he did have some peripheral neuropathy in his legs a little not bad and it has disappeared. We shaved his head not wanting to "wait and see." He was tired and nausious, but I think he would have done better if he drank more water which he refused to do, as he only drank "enough."

He took a few days off with the first round and 2 with his second. Not bad.

The ten pounds was not desired, but no harm, no foul- he lost it and I think it was from the steriods.

The Oncologist has not expressed any so far, we went to him with a binder full of studies and ironically he came to the appointment with the LANCET article recommending it. It was a match.

Medical insurance absolutey covered it all minus the co-pay. No questions asked.

Please feel free to ask anything. I understand it is contraversial to some and I absolutely respect the opinions and decisons of everyone on this web group. I am happy to share anything that may help you.

Kelly (Tim's Wife)

[Scott]

no use to explain this so many times.

My apologies if my post frustrated you, Krokar. I was just trying to present a little of both sides.

[veryworriedmom]

Paul, I read some similar studies about surveillance in pure seminoma regarding age of patient. The info I saw was that the younger the person the percentage goes up slightly. I believe they used age 35 in the studies and they also used size of original tumor>4cm together with age to give data . My son was given the surveillance/radiation option although the chemo was mentioned briefly. The reason he chose surveillance was that at 23 he thought he had too many years ahead to worry about complications from radiation but understands with reoccurance radiation would not be an option. It is a very individual decision. Second opinion for him supported surveillance too. he figured he would save the chemo for future if needed. Marion

[TimsWife]

Nope, no hair loss.