Surveillance Alone is Safe for Stage 1 Seminoma

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CHICAGO―Postsurgical surveillance alone allows patients with early-stage seminoma to forego unnecessary additional therapy without reducing cancer-specific survival (CSS), report authors of a registry study presented at the 2013 American Society of Clinical Oncology (ASCO) Annual Meeting.

Data for 1,822 men diagnosed with stage 1 seminoma during 1984-2008 who had been treated with orchiectomy (removal of the affected testicle and spermatic cord), retrieved from a national database in Denmark, revealed a 15-year CSS rate of 99.5%, reported lead author Mette S. Mortensen, MD, of Copenhagen University Hospital in Denmark, and coauthors. Mortality and cause-of-death data were updated in November 2012.

“Surveillance is a safe strategy for stage 1 seminoma patients,” Dr. Mortensen said.

Surveillance consisted of 5 years of scheduled physical exams, chest x-rays, computed tomography scans, and blood tests. In the United States, only about half of patients currently undergo postsurgical surveillance without additional therapy.

“To our knowledge, this study is the largest to address this issue in patients with stage 1 seminoma, and with the longest follow-up,” Dr. Mortensen said. “Now we have solid proof that surveillance is safe and appropriate for most patients with this particular cancer.”

The recurrence rate was 19.5% (n=355), with most (257 patients; 72%) relapses occurring within 2 years of orchiectomy. The median time to relapse was 13.7 months (range, 1.2-173 months), Dr. Mortensen noted. Only 7% of patients relapsed after year 5.

“Invasion of small blood or lymphatic vessels, tumor size larger than 4 cm, and serum chorionic gonadotropin higher than 200 IU/L were all independent prognostic factors for relapse,” the coauthors reported. (The P values for these prognostic factors were: small vessel invasion, P=0.0003; tumor larger than 4 cm, P=0.0086; hCG, P=0.0096.)

“This important study is one of several recent reminders that sometimes ‘less is more',” avoiding the harmful side effects that can be associated with unnecessary therapy, noted ASCO President-Elect Clifford Hudis, MD.

Seminoma represents approximately 50% of testicular cancers diagnosed each year, and stage 1 seminomas are newly diagnosed in approximately 4,000 men in the United States each year.

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