Better Testicular Cancer Outcomes with Active Surveillance
Late, advanced stage relapse rarely seen and are treatable with standard therapy.
Active surveillance for clinical stage I (CSI) testicular cancer leads to excellent outcomes, according to a study published online in the Journal of Clinical Oncology.
Christian Kollmannsberger, M.D., from University of British Columbia in Vancouver, Canada, and colleagues retrospectively studied data from 2,483 CSI patients: 1,139 CSI nonseminoma and 1,344 CSI seminoma managed with active surveillance. Most were treated between 1998 and 2010.
The purpose of the study was to evaluate active surveillance as a management strategy and to acquire patient data regarding timing and type of relapse.
The researchers found that relapse occurred in 221 (19 percent) CSI-nonseminoma and 173 (13 percent) CSI-seminoma patients. For lymphovascular invasion-positive CSI nonseminoma, the median time to relapse was four months, but was eight months for lymphovascular invasion-negative CSI nonseminoma and 14 months for CSI seminoma.
Relapses were detected by computed tomography scan in 87 percent of seminoma recurrences, in 48 percent of lymphovascular invasion-negative patients, and 41 percent of lymphovascular invasion-positive patients, while tumor markers detected recurrences in 3, 38, and 61 percent, respectively.
There were three disease-related deaths in patients with CSI nonseminoma, while one patient with CSI seminoma and two patients with CSI nonseminoma died because of treatment-related events. Both early- and late-relapse patients had advanced disease. Standard therapy cured all late recurrences. Five-year disease-specific survival was 99.7 percent.
"These data may inform further refinement of rationally designed surveillance schedules," the authors write.
One author disclosed financial ties to the pharmaceutical industry.