Introduction and Objectives
Radiotherapy (Rtx) is associated with an increase risk of 2nd cancer and cardiovascular disease (ds). Because of difficulties in detecting recurrences on surveillance who can occur out to 10 years (y) this institution has introduced carboplatin (CBDCA) chemotherapy (CT) as the treatment of patients (pts) in clinical stage (CS) A seminomatous testicular tumors (STT) and this study analyze late events in these 2 cohorts.
Material and Methods
Between 1982 and 2005, 545 pts in CS-A STT were randomized to receive either Rtx (n = 315) (TD 30 Gy) (Arm A) or 2 cycles of CBDCA CT (400 mg/sqm/q 3wks) (Arm B) (n = 230).
Results
Arm A – overall relapse rate (ORR) occurred in 13 pts (14.1%) with late relapse (LR) in 4 pts (1.3%) within median free interval (MFI) of 31 months (m). CR following applied therapy in relapse is achieved in 3 pts (75%). 10 pts (3.2%) developed metachronous GCT within MFI of 6.5 y (3 pts had discordant histology, 6 pts underwent surveillance). Late sequels were observed in 24 pts (7.6%): gastric ulcer (2), gastritis (3), ileus (2), dyspepsia (2), myelopathie (1), myelosupression (1) cardiovascular disturbances (3) and fibrosis within Rtx fields (7). 9 pts (2.9%) developed 2nd malignancy within MFI of 5 y: lung cancer (3), lung cancer/non-Hodgkin lymphoma (1), gastric cancer (1), thyroid cancer (1), bladder cancer (1), melanoma (1), ureteral tumor (1). At MFU of 12 y, DSS is achieved in 95.2% pts. Overall mortality rate was 4.8% (1.3% from GCT, 1.9% from 2nd malignancy and 1.9% from other causes). Arm B – ORR was 2.6% with LR in 2 pts (0.9%) within MFI of 31 m. All relapsing pts achieved CR with cisplatin-based CT. Metachronous GCT occurred in 4 pts (1.7%) within MFI of 20.25 m (3 pts had discordant histology, organ preserved operation is performed in 3 pts, surveillance in 3 pts). At MFU of 7 y (38 >10 y, 138 >5 y), DSS was 100%, 1 pt (0.4%) died from lung cancer at 28 m and 1 pt died of cardiovascular disorders at 45 m.
Conclusions
The numbers of cases were too small to be absolutely confident of these figures. However, this data strongly suggests that there are no excess of cancer or cardiovascular deaths in the single agent CBDCA cohort.
Article info
Identification
Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
