Abstract 794P
Background
Outcomes for men with stage I seminoma are excellent and avoiding intensive chemotherapy in these young patients is important. CT surveillance is a standard of care following orchiectomy. 10-20% relapse, but treatment is curative in almost 100%. In an ongoing trial of surveillance in seminoma [TRISST, NCT00589537], RMH stage IIC or worse relapse is defined as the primary outcome, reflecting the watershed for treatment with combination chemotherapy (BEP/EP) when TRISST was initiated. To re-assess the relevance of this endpoint we planned to assess current UK practices in treating relapse.
Methods
In 2020, a survey of UK clinicians was conducted to determine factors affecting management decisions at relapse, and the treatments recommended according to tumour stage or size.
Results
28 clinicians (24 centres) responded representing the majority of UK centres treating testicular cancer. 23 (82%) consider both stage and IGCCCG factors in determining relapse treatment, either with (57%) or without (25%) tumour size. In stage IIC disease, of 27 respondents, all indicated use of BEP/EP (3/4 cycle) or 3-4 cycles of carboplatin AUC10 (HDC); with only 3 (11%) also considering radiotherapy (RT, with carboplatin AUC7x1) as an option. Treatment of IIB disease was more varied: whilst 9 (of 27 respondents, 33%) only use BEP/EP and 5 (19%) only use HDC, 13 (48%) use RT +/- carboplatin AUC7 as either the only treatment (9, 33%) or as an option (4, 15%). However, when size is considered: for >3cm relapses, patterns were similar to IIC disease, but below 3cm management of stage IIB disease was less consistent. A subgroup of respondents use BEP/EP or HDC for all stage of seminoma relapse. 3 cycles of BEP is the most common combination regimen (20, 71%).
Conclusions
Tumour size is significant in relapsed seminoma.
Clinical trial identification
MREC: 07/H1306/127 NCT00589537.
Editorial acknowledgement
Legal entity responsible for the study
Medical Research Council.
Funding
CTAC UK.
Disclosure
All authors have declared no conflicts of interest.