Elsevier

Urology

Volume 60, Issue 2, August 2002, Pages 324-328
Urology

Adult urology
Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study

https://doi.org/10.1016/S0090-4295(02)01708-9Get rights and content

Abstract

Objectives. To evaluate the long-term oncologic efficacy and morbidity of carboplatin monotherapy, which was introduced at our department 11 years ago for the treatment of Stage I seminoma. Radiotherapy is the standard treatment of patients with clinical Stage I seminoma. Carboplatin has been advocated as a treatment alternative to avoid the late side effects of radiotherapy and the high recurrence rate of surveillance strategies.

Methods. From February 1990 until August 2001, 108 patients received two adjuvant cycles of single-agent carboplatin (400 mg/m2 body surface on days 1 and 22) 2 weeks after high inguinal orchiectomy. To assess for myelosuppression, complete blood counts were performed at least once a week until the nadir occurred after the second treatment cycle.

Results. During a mean follow-up period of 59.8 months (range 6 to 134), 2 patients (1.85%) developed a recurrence (retroperitoneal tumor) within the first year. Both patients received cisplatin-based salvage chemotherapy. At last follow-up, all patients were alive without any evidence of disease. Carboplatin treatment was well tolerated by all patients and was associated with only mild gastrointestinal side effects. Leukopenia was noted in 32 patients (29.6%); 21 (19.4%) of these patients had World Health Organization (WHO) grade 1, 8 (7.4%) had grade 2, 3 (2.8%) had grade 3, and none had grade 4. No patient developed neutropenic fever. Thrombocytopenia was observed in 48 patients (44.4%); of these patients, 38 (35.2%) had WHO grade 1, 5 (4.6%) had grade 2, 2 (1.9%) had grade 3, and 3 (2.8%) had grade 4.

Conclusions. From an oncologic standpoint, two cycles of carboplatin monotherapy was highly effective and very well tolerated by all patients.

Section snippets

Material and methods

Patients with histologic evidence of pure clinical stage I seminoma and clear surgical margins were eligible for single-agent carboplatin chemotherapy. Staging was performed according to the criteria recommended by the “Workshop for Staging and Treatment of Testicular Cancer” (Lugano 1979). In addition, computed tomography of the thorax, abdomen, and pelvis, as well as blood chemistry, including alpha-fetoprotein, beta-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH)

Results

The pathologic tumor stage in the 108 patients was pT1 in 88, pT2 in 16, and pT3 in 4 patients. Small vessel invasion occurred in 13 patients (12%). In 13 patients (12%), the tumor was more than 6 cm in size, and 95 patients had tumors 6 cm or less in size. At the time of orchiectomy, 49 patients (45.3%) were 34 years old or younger. Of the 108 patients, 13 presented with preoperatively elevated beta-HCG levels; 10 patients had levels between 10 and 80 mU/mL and 3 patients had higher levels

Comment

Clinical Stage I seminoma is a highly curable disease with a very low death rate. With the above-mentioned treatment strategies, the disease-specific survival rate approaches 100%.8 Postorchiectomy radiotherapy to the para-aortic and ipsilateral pelvic lymph nodes has been the reference standard adjuvant treatment for clinical Stage I seminoma in the past decades.1, 8 The radiation field was recently restricted to the para-aortic lymph nodes, yielding equal results in terms of survival and

Conclusions

Overall, the results of our study confirm several published reports that in patients with clinical Stage I seminoma of the testis, two cycles of carboplatin monotherapy is an oncologically effective and well-tolerated treatment modality associated with very low morbidity.

References (29)

  • S.D. Fossa et al.

    Optimal planning target volume for stage I testicular seminomaa Medical Research Council randomized trial

    J Clin Oncol

    (1999)
  • M. Bamberg et al.

    Radiotherapy for stages I and IIA/B testicular seminoma

    Int J Cancer

    (1999)
  • U. Ruther et al.

    Second malignancies following pure seminoma

    Oncology

    (2000)
  • A. Horwich et al.

    Use of carboplatin in germ cell tumors of the testis

    Semin Oncol

    (1992)
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