Two cycles of adjuvant carboplatin in stage I seminoma: 8-year experience by the Hellenic Cooperative Oncology Group (HECOG)

• Published in: World journal of urology Vol. 34; no. 6; pp. 853 - 857
• Main Authors: Koutsoukos, Konstantinos, Tzannis, Kimon, Christodoulou, Christos, Karavasilis, Vasilios, Bakoyiannis, Charalambos, Makatsoris, Thomas, Papandreou, C. N., Pectasides, Dimitrios, Dimopoulos, Meletios A., Bamias, Aristotelis
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2016; Springer Nature B.V
• Subjects: Adult; Antineoplastic Agents - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - administration & dosage; Chemotherapy, Adjuvant; Cisplatin - therapeutic use; Etoposide - therapeutic use; Humans; Male; Medicine; Medicine & Public Health; Neoplasm Staging; Nephrology; Oncology; Original Article; Retrospective Studies; Seminoma - drug therapy; Seminoma - pathology; Testicular Neoplasms - drug therapy; Testicular Neoplasms - pathology; Time Factors; Urology; Two cycles of carboplatin; Seminoma; Stage I
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-015-1695-0

Purpose
Following the establishment of adjuvant carboplatin in stage I testicular seminoma as a standard, we adopted this treatment for all stage I seminoma patients. We report our 8-year experience and compare these results with our previous adjuvant etoposide/cisplatin (EP) strategy.
Patients and methods
Patients with stage I seminoma, treated with adjuvant carboplatin and with a minimum follow-up of 1 year, were included. Two cycles of carboplatin [area under the curve (AUC) 6] were administered.
Results
A total of 138 patients with median age of 34 years, treated from September 2003 to December 2011, were selected. There were 5 relapses [5-year relapse-free rate (RFR) 96.8 % (95 % confidence interval 91.6–98.8)]: 3 relapses at retroperitoneal lymph nodes, 1 relapse at the adrenal gland, and 1 isolated brain metastasis. Four patients with relapse were cured with salvage chemotherapy. All patients with relapse had tumor diameter ≥4 cm and/or age ≤34 years. Patients with at least 1 of the above risk factors (
n
 = 111) had a significantly higher relapse rate compared with a similar population (
n
 = 64) treated with 2 cycles of adjuvant EP: 5-year RFR was 95 % (SE 2 %) versus 100 % (SE 0 %), (
p
 = 0.067).
Conclusions
Age and tumor diameter were associated with relapse in stage I seminoma treated with adjuvant carboplatin. Although adjuvant carboplatin in patients with age ≤34 and/or tumor diameter ≥4 cm is associated with higher relapse rates than EP, the prognosis of these patients is excellent, and therefore, the use of less toxic treatment is justified.