Introduction and Objectives
Radiotherapy (Rtx) has been the standard treatment of patients (pts) with clinical stage A (CS-A) seminomatous testicular tumors (STT) for decades. Carboplatin (CBDCA) has been advocated as an effective treatment alternative to avoid well known late effects of Rtx (2nd cancer, gastrointestinal and cardiovascular toxicity) and the high recurrence rate of surveillance. Since CBDCA chemotherapy (CT) was initiated more than 18 years ago, we evaluated the long term oncologic effectiveness and morbidity.
Material and Methods
Between 1982 and 2005, 230 pts received adjuvant single-agents CBDCA CT (400 mg/sqm/q 3 weeks), 2–3 weeks after radical orchiectomy: 222 pts received 2 cycles and 8 pts with persistently elevated hCG postorchiectomy 3–4 cycles. In all pts CT could be performed on outpatient basis during 2 h.
6 pts (2.7%) relapsed within median free interval (MFI) of 13.8 months (m) (range 4–34) (RPLN 5, only elevated hCG 1), including 2 late relapses at 28 and 34 m. All relapsing pts achieved CR with cisplatin-based CT. Among 476 treatment cycles no life treating toxicity was observed. Mild gastrointestinal discomfort occurred in 40 pts (17.4%). Myelosupression was minimal with none pts demonstrated leucopenia or thrombocytopenia gr. II-III. CBDCA CT was not associated with alopecia, renal, neuro or ototoxicity. Metachronous GCT occurred in 4 pts (1.7%) within MFI of 20.2m (range 4–36) (3pts had discordant histology, organ preserved operation is performed in 3 pts, surveillance in 3 pts). At median follow-up of 7 years (y) (range 3–13) (38 >10 y, 138 >5 y) disease specific survival is 100%, 1 pt (0.4%) died from lung cancer at 28m and 1 pt (0.4%) of cardiovascular disorders at 45 m.
Long term results confirm early reports – in CS-A STT 2 cycles of CBDCA CT were found highly effective from an oncologic standpoint and associated with only minimal morbidity.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.