Originally published as JCO Early Release 10.1200/JCO.2005.01.9810 on October 31 2005

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Risk-Adapted Management for Patients With Clinical Stage I Seminoma: The Second Spanish Germ Cell Cancer Cooperative Group Study

From the Departments of Medical Oncology, Hospital Universitario La Fe; Hospital Universitari Doctor Peset, Valencia; Idibell-Institut Catalá d'Oncologia Duran i Reynals; Hospital de Sant Pau; Hospital Mutua de Terrassa; Hospital del Mar; Hospital Clinic i Provincial, Barcelona; Hospital General Universitario Gregorio Marañón; Hospital Universitario 12 de Octubre, Madrid; Hospital Clínico Universitario Lozano Blesa, Zaragoza; Hospital Universitari Germans Trias i Pujol, Badalona; Hospital Universitari Josep Trueta, Girona; Hospital Universitari Sant Joan, Reus; Hospital Clínico Universitario Virgen de la Victoria, Málaga; Hospital Donostia; Instituto Oncológico de Guipúzcoa, San Sebastián; Hospital Universitari Arnau de Vilanova, Lleida; Hospital Universitario Marqués de Valdecilla, Santander; and Hospital Provincial, Castellón, Spain

Address reprint requests to Jorge Aparicio, MD, Servicio de Oncología Médica, Hospital Universitario La Fe, Avda Campanar 21, E-46009 Valencia, Spain; e-mail: japariciou{at}seom.org

PURPOSE: To assess the efficacy of a risk-adapted treatment policy for patients with stage I seminoma by using universally accepted risk criteria.

PATIENTS AND METHODS: Between 1999 and 2003, 314 patients with clinical stage I seminoma after orchiectomy were prospectively included. One hundred patients (31.8%) presented no risk factors and were managed with surveillance. In contrast, 131 patients (41.7%) had tumors larger than 4 cm, 33 patients (10.5%) had rete testis involvement, and 50 patients (15.9%) had both risk factors. All the latter received two courses of adjuvant carboplatin.

RESULTS: Chemotherapy was well tolerated, as only 17 patients (7.9%) presented grade 3 to 4 toxicity. Relapses were observed in six patients (6.0%) on surveillance and in seven patients (3.3%) treated with carboplatin (0.8% of tumors larger than 4 cm, 9.1% of those involving the rete testis, and 6.0% of patients with both risk criteria). All were located at the retroperitoneum, except for one at the spermatic cord. Median tumor size was 25 mm (range, 11 to 70 mm), and median time to relapse was 9 months (range, 4 to 28 months). All patients were rendered disease-free with chemotherapy (etoposide plus cisplatin). Median follow-up was 34 months (range, 12 to 72 months). The actuarial 5-year disease-free survival rate was 93.4% for patients on surveillance and 96.2% for patients treated with adjuvant chemotherapy. Overall 5-year survival was 100%.

CONCLUSION: Adjuvant carboplatin is effective in reducing the relapse rate in patients with stage I seminoma and risk factors. A risk-adapted strategy is safe and feasible and should be considered an alternative to systematic approaches, such as irradiation, chemotherapy, or surveillance.

Presented in part at the 40th Annual Meeting of the American Society of Clinical Oncology, June 5-8, 2004, New Orleans, LA.

See online Appendix for other Germ Cell Cancer Cooperative Group members participating in the study.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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