867P - Experience with single agent adjuvant carboplatin for stage I seminoma - a retrospective analysis

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Anti-Cancer Agents & Biologic Therapy
Germ Cell Tumours
Presenter Hajnalka Nemeth
Authors H. Nemeth, Z. Küronya, K. Biro, I. Bodrogi, L. Geczi
  • Chemotherapy C And Clinical Pharmacology, National Institute of Oncology, 1122 - Budapest/HU

Abstract

The cure rate for stage I seminoma is above 99%, and current adjuvant strategies aim to maintain this favorable result with less therapy related toxicity. Adjuvant therapeutic options include irradiation of the para-aortic lymph nodes, single agent carboplatin and surveillance. There is an increased risk of relapse in case of tumor size > 4 cm and rete testis infiltration, so as a risk adapted strategy, to patient with these risk factors, adjuvant therapy can be advised. We retrospectively analyzed the data of our patients, who received adjuvant carboplatin for stage I seminoma in order to assess the safety and efficacy of this treatment. From November 2006 till the end of 2011, 275 patients were treated or intended to treat with two courses of adjuvant carboplatin in the dose of area under the curve 7 after orchiectomy. One hundred and thirty two patients (48%) had tumors > 4cm, 131 patients (47.6 %) had ≤ 4 cm, and we had no data of 12 patients (4.4%). The tumor invaded the rete testis in 103 patients (37.4 %), the rete testis was tumor-free in 70 patients (25.4 %) and data was not available in 102 patients (37.2%). We had data for both risk factors in 166 patients (60%). Fifty one patients (30.7%) had two risk factors, 72 of them (43.3%) had one, and 43 patients (26%) had no risk factors. Ten patients received only one course of carboplatin. We experienced grade 3 side effects in 4 patients (vomiting, low platelets, neutropenia, deep vein thrombosis). No toxicity of higher grade developed. Seven patients relapsed. All relapses occurred in the retroperitoneal lymph nodes. In two patients, the retroperitoneal lymph node metastases were discovered after the first cycle of carboplatin, so these cases are not considered real relapses, but rather the mistake of the initial staging. To conclude, single agent carboplatin proved to be a safe and effective treatment. The risk adapted strategy is not consistently used in our everyday practice. We aim to improve the quality of the initial staging to avoid false stage I assessments. We also have to promote the more accurate pathologic examination of the specimens to be able to correctly inform the patients on the risk of relapse and thus enable them to make a fully informed decision on their adjuvant treatment.

Disclosure

All authors have declared no conflicts of interest.