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• W2031930249 abstract "Management options for stage I seminoma of the testis after radical inguinal orchiectomy (RIO) are diverse and range from post-operative adjuvant radiotherapy (RT) to surveillance alone with the reservation of RT or chemotherapy for the salvage of relapse. Surveillance strategy has been feasible because of better understanding of relapse pattern, the application of high-quality imaging tools for early detection of relapse, and the availability of highly effective salvage treatment for relapse. The aim of this report is to examine a long-term outcome and patterns of relapse in stage I testicular seminoma managed with surveillance alone after RIO. A prospective, single arm, study was conducted to evaluate surveillance strategy for stage I testicular seminoma. Patients must have met the following eligibility criteria: 1. Histologic diagnosis of seminoma, 2. RIO, 3. No evidence of nodal or distant metastasis, 4. Absence of tumor in the cut end of the spermatic cord, 5 Normal post-operative serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (bHCG), 6. Informed consent. Patients received no post-operative adjuvant therapy. Instead, they were followed closely in accordance to regular, pre-defined, schedules. Surveillance evaluations included: 1. Physical examination, AFP, bHCG, and Chest x-ray: q2months for year 1–2, q6months for year 3–5, and yearly thereafter, 2. CT scan of abdomen and pelvis: q4months for year 1–2, q6months for year 3–5, and yearly thereafter. The study accrued a total of 88 patients with stage I testicular seminoma between 1986 and 1996. Median age at the time of RIO was 34 years (range: 20–66). The most common presenting complaint was a painless testicular mass. Six patients gave a history of cryptorchidism and four of them underwent orchiopexy. None had trans-scrotal biopsy prior to RIO. Median follow-up as of June 2003 was 12.1 years (range: 1–18.3). In 3 patients, follow-up was less than 2 years, as they failed to return to the clinic for surveillance. 71 remained free of relapse, while 17 relapsed. Actuarial relapse-free rates were 83%, 80%, and 80% at 5, 10, and 15 years, respectively. Median time to relapse was 13.6 months (range: 6.9–86.5). Only 2 had a late relapse beyond 5 years after RIO. Relapse sites of the 17 patients were: 12: paraaortic (PA) nodes only, 1: PA and external iliac nodes, 2: inguinal nodes, 1: PA and mediastinal nodes, 1: mediastinum and lung. Relapse was first detected by radiological investigations in 15 cases, and by clinical assessment in 2. The 2 cases detected clinically were those with isolated inguinal node relapse. 3 out of 6 patients with a history of cryptorchid and/or orchiopexy had relapse (2 in the ipsilateral inguinal nodes and 1 in the PA nodes). None had elevated bHCG or AFT at the time of recurrence. Of the 17 relapsed, 14 were treated with RT and 3 with chemotherapy (bleomycin, VP-16, cisplatin). Only 1 had a second relapse. This patient, initially treated with RT for the first relapse, was further salvaged by chemotherapy. All 17 relapsed patients have remained free of recurrence after salvage treatment with median follow-up of 10.5 years (range: 6.2–15.3). None died of seminoma. There were 2 deaths in the cohort: one due to myocardial infarct and the other due to cerebrovascular accident. Factors assessed for predictive factor for relapse were age, elapsed time from the detection of testicular mass to RIO, tumor size, invasion into the rete testis, invasion into the tunica, vascular/lymphatic invasion, and the presence of syncytiotrophoblast element. The only significant predictive factor for relapse on Cox proportional hazards model was the presence/absence of rete testis invasion (hazard ratio=3.5, p = 0.026). Surveillance with reservation of RT or chemotherapy for salvage of relapse is a safe alternative to upfront postoperative adjuvant therapy for stage I testicular seminoma" @default.
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• W2031930249 date "2004-09-01" @default.
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• W2031930249 title "Surveillance is a safe alternative to up-front post-operative adjuvant therapy for stage I testicular seminoma after radical inguinal orchiectomy" @default.
• W2031930249 doi "https://doi.org/10.1016/j.ijrobp.2004.07.053" @default.
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