Management of stage I testicular seminoma: A retrospective study from Institute of Oncology “Ion Chiricuta”, Romania

Aim/Background

A retrospective study that evaluated treatment outcomes and risk factors for stage I testicular seminoma treated at Institute of Oncology Ion Chiricuta, Romania.

Methods

Our series included 150 patients, age between 19 and 78 years (median age-36 years) stage I pure seminoma assessed between January 1982 and January 2009 and treated at Institute of Oncology “Ion Chiricuta”, Romania. For inclusion in the final analysis patients had to fulfill the following inclusion criteria: male, age minimum 14 years old, confirmed GCT either by histology and/or serum tumor markers and sufficient follow-up 135.8 months (range minimum 3 - maximum 233 months). The adjuvant setting consisted of one cycle Carboplatin AUC 7(area under curve 7) or two cycles Carboplatin AUC 6 (area under curve 6) or radiotherapy or surveillance.

Results

At the time of the analysis the overall survival at 10 years was 94% (CI: 88%-97%). One hundred seminoma patients (80%) had no relapse, metastatic relapse was observed in 6 patients (4%), pelvic or lomboaortic lymph nodes were present in 21 patients (14%), metastatic and node relapse in 2 patients (1,33%) and seric relapse in 1 patient(0,67%). The following risk factors for relapse were assessed: age at presentation (<40 vs. >40 years, p = 0.03), ECOG performance status ( 0-91%, 1-62%, 2-25%, p < 0.01) and stage at initial presentation (IA-63%, IB-65%, IS-90%, p < 0.03).Chemotherapy toxicity was moderate, main toxicity for Carboplatin was thrombocytopenia (6,67%), anemia(3,7%), leucopenia (3,33%), and nausea and vomiting (3,33%).

Conclusions

The prognostic values for patients with stage I pure seminoma in our series was excellent. The rate of curability for adjuvant setting was high, the overall survival at 10 years with adjuvant chemotherapy was 98%, with adjuvant radiotherapy 93% and overall survival for patients treated with orchiectomy and managed by surveillance was 37%. We conclude that treatment decisions regarding stage I testicular seminoma should rest on late toxicities, morbidity and patient preference.

Clinical trial identification

Disclosure

All authors have declared no conflicts of interest.