Background

Stage I seminoma is the commonest presentation of testicular germ cell tumours. It has a greater than 98% 5 year OS, but surveillance studies suggest a relapse rate of 15-20%.¹ Three management approaches have been investigated: surveillance, adjuvant radiotherapy and carboplatin chemotherapy. This retrospective study compares 3 cohorts to assess changes in practice over 10 years in a regional cancer unit.

Method

We conducted a retrospective audit of all stage 1 seminoma patients presenting in 2003-4, 2008-9 and 2011-12. Data collected includes; age, risk factors (tumour size, rete testis invasion), management, and outcome.

Results

65 patients were identified. Median age; 39. Relapse rate; 9%. All relapses were in the surveillance arm; 66% had risk factors for relapse. 1 death (not related to cancer).

In 2003/4 cohort (n = 16) 94% of patients had adjuvant radiotherapy; 6% opted for surveillance. 2008/9 cohort (n=29); 72% underwent surveillance and 28% had adjuvant RT (no chemotherapy given). 2011/12 cohort (n = 20); 75% patients had adjuvant chemotherapy, 20% surveillance, 5% radiotherapy (n=1; not medically fit for chemotherapy).

90% of patients with 2 risk factors underwent adjuvant treatment. The presence of 2 risk factors was not a statistically significant predictor of treatment uptake (p=0.09, X² test), due to small sample size.

Conclusion

We have demonstrated the evolution of adjuvant management in stage I seminoma. In 2003/4 the majority of patients received adjuvant radiotherapy. In 2008/9 most underwent surveillance when evidence emerged supporting its use.² In 2011/12 the majority opted for adjuvant chemotherapy as the literature demonstrated its non-inferiority to RT.³ There was a similar uptake of adjuvant therapy in those with no or 1 risk factor for relapse (58% and 50% respectively) but more (90%) in patients with both risk factors; suggesting that this influences the uptake of adjuvant treatment.