Management of clinical stage I seminomatous testicular cancer: A report from SWENOTECA.

Genitourinary (Nonprostate) Cancer
Session Type and Session Title: 
Oral Abstract Session, Genitourinary (Nonprostate) Cancer
Abstract Number: 
J Clin Oncol 32:5s, 2014 (suppl; abstr 4508)
Torgrim Tandstad, Eva Cavallin-Stahl, Olav Dahl, Hege Sagstuen Haugnes, Carl Wilhelm Langberg, Anna Laurell, Jan Oldenburg, Ulrika K. Stierner, Arne Solberg, Karin Soderstrom, Olof Stahl, Najme Wall, Gabriella Elisabeth Cohn-Cedermark, SWENOTECA; The Cancer Clinic, St. Olavs University Hospital, Trondheim, Norway; Department of Oncology, Skane University Hospital, Lund, Sweden; Institute of Medicine, Section of Oncology, University of Bergen, Bergen, Norway; University Hospital of Northern Norway, Tromsø, Norway; Division of Cancer Medicine and Radiotherapy, Oslo University Hospital, Oslo, Norway; Department of Oncology, Uppsala University, Uppsala, Sweden; Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Department of Oncology, Sahlgrenska University Hospital, Göteborg, Sweden; St. Olav's Hospital, Trondheim, Norway; Umeå University Hospital, Umeå, Sweden; Lund University Hospital, Lund, Sweden; Institute of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden; Department of Oncology-Pathology, Karolinska Institute and University Hospital, Stockholm, Sweden

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Abstract Disclosures


Background: Clinical stage I seminoma testicular cancer is the most frequent presentation of testicular cancer. Current treatment option include surveillance (SURV) or adjuvant chemotherapy. Following a large randomized phase III study, 1 course of adjuvant carboplatin (AC) AUC7 became the preferred adjuvant treatment option. Methods: A risk-adapted protocol (SWENOTECA VII) was initiated in 2007, based on the proposed risk factors; invasion of rete testis and tumor size >4cm. Patients with 0-1 risk factor were recommended SURV, but could choose 1 course of AC (AUC7). Patients with 2 risk factors were recommended 1 course of AC, but could choose SURV. We also report treatment results from patients treated with AC in an earlier protocol during 2004-2007. Results: 839 patients were included in the SWENOTECA VII protocol. In addition 225 patients were treated with AC before 2007. Median follow-up is 4.0 years, 3.6 years for patients on SURV and 4.2 years for patients treated with AC. In total 675 patients were treated with AC, and 389 patients chose SURV. Complete information regarding risk factors was available in 946 patients. The relapse-rate (RR) following AC was 6.2 %; in patients without risk factors 2.7 % compared to 9.4 % in patients with 1-2 risk factors. In patients followed by SURV the RR was 10 %; in patients without risk factors 2.9 %, compared to 21.7 % in patients with 1-2 risk factors. Conclusions: In this modern, large, population-based prospective study we confirm the low relapse rate previously reported for patients with 0 risk factors on SURV, thus patients with no risk factors should be followed by SURV. The RR with AC was somewhat higher than reported in MRC TE19/EORTC 30982. This may be due to the risk-adapted approach, with a higher proportion of patients with 1-2 risk factors treated with AC. The RR following AC indicated a relatively modest effect in preventing relapse. Data regarding exact doses are being collected to assess if inadequate dosing may have affected the RR following AC.