Purpose: To describe treatment results in 4 cohorts of patients with stage I seminomatous germ cell cancer (SGCC) treated within 4 different risk-adapted surveillance strategies according to national guidelines.
From January 1, 1994, to December 31, 2015, 186 patients with stage I SGCC, were included in 4 different cohorts and treated within different risk-adapted surveillance strategies. Group 1: 994 to 1999, patients with T > T1 received two cycles of carboplatin (CBDCAx2), Group 2:1999 to 2003, patients received CBDCAx2 if either tumour size >4 cm or rete testis invasion, Group 3: 004 to 2009, patients received CBDCAx2 if both tumour size >4cm and rete testis invasion were present, and Group 4: patients received CBDCAx1 cycle if either rete testis invasion or size >4 cm were present, two patients that received radiotherapy were included in Group 4. Follow-up consisted of serum tumour markers and physical exam every 3 months plus abdominal CT scans every 6 m the first two years, and at longer intervals thereafter.
Disease-specific survival: 100%. Three patients died, one because car accident, two patients due to metastatic colorectal and pancreatic cancer. Table summarize results by cohort: N CBDCA (relapse) Follow-up PFS (5yr) Platinum/ patient Group 1 38 8 (0) 30 (3) 92% 25, 0.67 Group 2 49 23 (1) 26 (3) 92% 58, 1.18 Group 3 52 18 (0) 34 (4) 91% 48, 0.92 Group 4 47 24 (3) 23 (3) 75% 42, 0.89 Relapse: All patients had good prognosis disease. Only one patient who progressed after 2 cycles of Carboplatin need TIP chemotherapy and finally High Dose Chemotherapy and he is currently free of disease 8 years later. A trend for a later relapse was observed in patients relapsing after being treated with carboplatin.
A risk adapted surveillance programme provided an overall specific survival of 100%. Relapse rate in patients receiving Carboplatin x 1 cycle seems to be higher than for patients included in protocols receiving Carboplatin x 2. Then number of total (CBDCA + CDDP) was higher for the Groups with CBDCAx2. These results suggest that vascular invasion was a better predictor for selecting patients for adjuvant chemotherapy, although the number of patient per cohort is low to provide final conclusions.
Clinical trial identification
Legal entity responsible for the study
Oncology Service, Germ Cell Cancer Unit, Hospital Sant Pau
All authors have declared no conflicts of interest.