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Oncology ; 95(1): 8-12, 2018.
Article in English | MEDLINE | ID: mdl-29587278

ABSTRACT

OBJECTIVE: The aim of this study was to assess a risk-adapted strategy for stage I seminoma guided by the presence of rete testis invasion. METHODS: Between January 2013 and December 2015, a total of 135 consecutive patients with stage I seminoma from 18 Spanish tertiary hospitals were included in a prospective multicenter study. Median patient age was 38 years (range 22-60). Preoperative beta-human chorionic gonadotropin was elevated in 9.6% of patients. Rete testis invasion was present in 47.4% of patients. After orchiectomy, subjects with rete testis invasion were treated with 2 courses of adjuvant carboplatin (area under the curve of 7, with 21-day interval). Those without this risk factor were managed by surveillance. Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method. RESULTS: After a median follow-up time of 33 months, only 6 relapses were recorded (5 on surveillance, 1 after carboplatin). These cases were rescued with BEP or EP chemotherapy, and all 135 patients are currently disease free without sequelae. Three-year DFS was 92.0 and 98.2% for patients on surveillance and after carboplatin, respectively. Three-year OS was 100%. CONCLUSION: A risk-adapted approach based on rete testis invasion as a single risk factor is feasible and yielded an excellent outcome with a 3-year DFS of 94.9%.


Subject(s)
Antineoplastic Agents/therapeutic use , Carboplatin/therapeutic use , Rete Testis/pathology , Seminoma/drug therapy , Seminoma/pathology , Testicular Neoplasms/drug therapy , Testicular Neoplasms/pathology , Adult , Chorionic Gonadotropin/blood , Combined Modality Therapy , Disease-Free Survival , Humans , Male , Middle Aged , Neoplasm Staging , Orchiectomy , Prospective Studies , Seminoma/surgery , Spain , Testicular Neoplasms/surgery , Young Adult
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