The Management of Relapsed Stage I Seminoma

摘要

Clinical stage I testicular seminoma now represents approximately 50% of the 8,500 new patients diagnosed with testicular cancer in the United States annually. Management options after orchidectomy include surveillance and adjuvant therapy of either radiotherapy (RT) or chemotherapy. Previously, the standard management of stage I seminoma has been adjuvant retroperitoneal RT; while providing excellent long-term results, this strategy has been associated with increased risks of late gonadal toxicity, cardiovascular disease, and development of secondary malignancies. Adjuvant chemotherapy using single-agent carboplatin has been investigated as a less-harmful adjuvant therapy, but since para-aortic nodal recurrence represents the main site of disease relapse, this necessitates ongoing abdominal imaging similar to surveillance (perhaps with less frequency). Other concerns with this strategy include over-treatment similar to adjuvant RT and as yet, poorly-defined late effects of treatment. It is now known that over 85% of patients are cured with orchidectomy alone, and with treatment reserved for relapse, surveillance is now the preferred management approach, minimizing the burden of treatment while maintaining the cure rate at 100%.