Results from 4 different risk-adapted surveillance strategies in a single Hospital for patients for stage I seminomatous germ cell tumours

Abstract

Background: Purpose: To describe treatment results in 4 cohorts of patients with stage I seminomatous germ cell cancer (SGCC) treated within 4 different risk-adapted surveillance strategies according to national guidelines. Methods: From January 1, 1994, to December 31, 2015, 186 patients with stage I SGCC, were included in 4 different cohorts and treated within different risk-adapted surveillance strategies. Group 1: 994 to 1999, patients with T > T1 received two cycles of carboplatin (CBDCAx2), Group 2:1999 to 2003, patients received CBDCAx2 if either tumour size >4 cm or rete testis invasion, Group 3: 004 to 2009, patients received CBDCAx2 if both tumour size >4cm and rete testis invasion were present, and Group 4: patients received CBDCAx1 cycle if either rete testis invasion or size >4 cm were present, two patients that received radiotherapy were included in Group 4. Follow-up consisted of serum tumour markers and physical exam every 3 months plus abdominal CT scans every 6 m the first two years, and at longer intervals thereafter. Results: Disease-specific survival: 100%. Three patients died, one because car accident, two patients due to metastatic colorectal and pancreatic cancer. Table summarize results by cohort: N CBDCA (relapse) Follow-up PFS (5yr) Platinum/ patient Group 1 38 8 (0) 30 (3) 92% 25, 0.67 Group 2 49 23 (1) 26 (3) 92% 58, 1.18 Group 3 52 18 (0) 34 (4) 91% 48, 0.92 Group 4 47 24 (3) 23 (3) 75% 42, 0.89 Relapse: All patients had good prognosis disease. Only one patient who progressed after 2 cycles of Carboplatin need TIP chemotherapy and finally High Dose Chemotherapy and he is currently free of disease 8 years later. A trend for a later relapse was observed in patients relapsing after being treated with carboplatin. Conclusions: A risk adapted surveillance programme provided an overall specific survival of 100%. Relapse rate in patients receiving Carboplatin x 1 cycle seems to be higher than for patients included in protocols receiving Carboplatin x 2. Then number of total (CBDCA + CDDP) was higher for the Groups with CBDCAx2. These results suggest that vascular invasion was a better predictor for selecting patients for adjuvant chemotherapy, although the number of patient per cohort is low to provide final conclusions.