Single dose of carboplatin is not inferior to radiotherapy in Stage I seminoma
Stage I seminoma is the most common testicular germ cell tumor; Radiotherapy used to play a central role in the treatment of this highly curable malignancy. Treatment strategies after orchiectomie now are surveillance, adjuvant radiotherapy or chemotherapy (carboplatin);
To compare the latter two strategies, a non-inferiority trial has been conducted; almost 1500 patients were randomly assigned to either a single dose carboplatin (AUC7) infusion or radiotherapy (20-30 Gy).
Oliver and colleagues now present the 6,5 year follow-up data of this trial confirming the non-inferiority of carboplatin to radiation therapy; relapse-free survival was comparable in both groups (Chx 95% vs RT 96%); In the chemotherapy group, less side-effects have been reported. Interestingly, the use of carboplatin also reduced the risk of contralateral germ cell tumors.
In conclusion, adjuvant chemotherapy is a valid alternative to adjuvant radiotherapy in stage I seminoma.
In the recent guidelines by the European germ cell consensus group, surveillance is recommended in most (low risk) cases as 88% of the patients are cured by orchiectomie alone. In case of a relapse, rates of curation are still high.
http://www.ncbi.nlm.nih.gov/pubmed/21282539 (Article)
http://www.ncbi.nlm.nih.gov/pubmed/18191324 (European Guideline by Consensus Group)
#seminoma #radiotherapy #chemotherapy #LMU