• J Aparicio, X García del Muro, P Maroto, L Paz-Ares, E Alba, A Sáenz, J Terrasa, A Barnadas, D Almenar, J A Arranz, M Sánchez, A Fernández, J Sastre, J Carles, J Dorca, J Gumà, A L Yuste, J R Germà, and Spanish Germ Cell Cancer Cooperative Group (GG).
• Hospital Universitario La Fe, Valencia, Spain. aparicio_josurt@gva.es
• Ann. Oncol. 2003 Jun 1; 14 (6): 867-72.

BackgroundAfter decades of irradiation as standard therapy for clinical stage I testicular seminoma, alternative treatment approaches have emerged including postorchiectomy surveillance and adjuvant chemotherapy. This study was performed to assess a dual policy of surveillance and selective single-agent carboplatin (for high-risk cases) in a multicenter setting.Patients And MethodsFrom 1994 to 1999, 203 patients with stage I seminoma were included. Sixty (29.6%) were considered poor-risk cases (i.e. with vascular invasion and/or pathological tumor stage pT2 or greater) and received two courses of adjuvant carboplatin, whereas 143 (70.4%) without risk criteria underwent close surveillance.ResultsMedian follow-up was 52 months (range 14-92). Relapses were observed in two (3.3%) patients treated with carboplatin and in 23 patients (16.1%) on surveillance, with a median time to recurrence of 11 months (range 3.9-39.6). All relapsing patients were rendered disease-free, mainly with cisplatin-based chemotherapy. Four patients died from tumor-unrelated causes. Actuarial 5-year overall survival was 96.7% and cause-specific survival was 100%. Five-year disease-free survival was 83.5% for patients on surveillance, and 96.6% for those receiving carboplatin.ConclusionsThis dual treatment policy is feasible in a multicenter setting and preserves 70% of patients from adjuvant chemotherapy. Single-agent carboplatin is effective in reducing the relapse rate in patients with high-risk stage I seminoma. A better definition of local risk features would probably improve patient selection, thus minimizing the incidence of recurrences on surveillance.

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