855P - Radiotherapy or chemotherapy for clinical stage IIA and IIB seminoma: A systematic review and meta-analysis of patient outcomes

Date 27 September 2014
Event ESMO 2014
Session Poster Display session
Topics Cytotoxic agents
Germ Cell Tumours
Surgical oncology
Therapy
Biological therapy
Radiation oncology
Presenter Patrizia Giannatempo
Citation Annals of Oncology (2014) 25 (suppl_4): iv280-iv304. 10.1093/annonc/mdu337
Authors P. Giannatempo1, T. Greco2, S. Tana3, N. Nicolai4, D. Raggi1, E. Farè1, B. Avuzzi3, M. Marongiu1, L. Piva5, M. Catanzaro5, D. Biasoni5, T. Torelli5, S. Stagni5, M. Maffezzini5, A.M. Gianni6, R. Salvioni4, L. Mariani7, A. Necchi1
  • 1Medical Oncology/urology Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 2Biostatistics, University of Milano, Milano/IT
  • 3Radiation Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 4Surgery Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 - Milan/IT
  • 5Surgery - Urology Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 6Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 - Milano/IT
  • 7Clinical Epidemiology And Trials Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 - Milano/IT

Abstract

Aim

Outcomes of radiotherapy (RT) compared to chemotherapy (CT) remain poorly defined for the management of clinical stage (CS) II seminoma, namely CSIIB, although some studies suggest an equal benefit. We aimed to update the current evidence on the role of RT and CT in this setting of advanced seminoma.

Methods

A comprehensive literature review was performed to identify all studies reporting on results of RT or CT in CSIIA and CSIIB seminoma. Search was limited to studies published after 1990 and included the Medline, Embase databases, and abstracts from ASCO (GU), ESMO, AUA, and ASTRO meetings up to 02/2014. A systematic review and meta-analysis (MA) was performed. Sensitivity analyses were applied by independently analyzing the effect of treatment in these subgroups: CSIIA and CSIIB, paraortic + iliac RT only in both stages, RT dose (≥30 Gy vs <30 Gy), and PEB/EP regimens only. A meta-regression model was also applied.

Results

13 studies have been selected for MA on relapse-free survival (RFS). No randomized trials compared RT and CT. There were 6 prospective and 7 retrospective studies, with a total of 527 patients receiving RT and 317 receiving CT. The pooled relapse-rate (RR) was similar between the RT (9%, 95%CI: 7-11, p for heterogeneity = 0.24, I-square = 22%, with 10 studies included) and CT groups (8%, 95%CI: 2-15, p for heterogeneity < 0.001, I-square = 81%, with 7 studies included). Furthermore, the slope of the regression to evaluate the effect of CT respect to RT on RFS risk did not result significantly different from zero (-0.46, 95%CI: -3.80-2.27, p = 0.772). The outcome was similar across the clinical stages and treatment modalities. Of note however, the pooled RR for RT in CSIIB was 14% (95%CI, 9-18) while it was 8% (95%CI, 2-15) for CT. For OS endpoint, 9 studies were available and the pooled mortality rate was similar using RT (1%, 95%CI: 0.2-2, p for heterogeneity = 0.57, I-square = 0%,) or CT (1%, 95%CI: 0.2-2, p for heterogeneity = 0.37, I-square = 6%, with 5 studies included).

Conclusions

Overall, RT and CT confirmed to be equal options in CSII seminoma. There appears to be a RFS benefit for CT compared to RT in CSIIB patients. This evidence is limited by the retrospective nature of studies and their relatively small sample size. Prospective randomized trials are needed to confirm the findings in CSIIB.

Disclosure

All authors have declared no conflicts of interest.