UK management practices in stage i seminoma and the medical research council trial of imaging and schedule in seminoma testis managed with surveillance

摘要

Stage I seminoma accounts for 40-45% of testicular cancers [1,2], 800-900 UK cases annually [3]. After orchid-ectomy, care includes one of three main options: adjuvant chemotherapy (one to two cycles of carboplatin), para-aortic radiotherapy or, as more than 80% of patients are cured by surgery [4,5], surveillance incorporating regular imaging. Relapse rates after adjuvant therapy are about 4-5% [6]. However, salvage therapy is highly effective and cause-specific survival approaches 100%, irrespective of initial management [7], Given such excellent prospects, and the young age of patients, long-term implications and risks must be considered. Avoidance of treatment side-effects through the use of surveillance may be a sensible and safe approach.Here we consider current evidence regarding the efficacy and potential risks of these management options. Based on surveys of UK oncologists treating testis cancer patients in 2005 and 2009, we assess current management practices and trends over time. We highlight the limitations of evidence relating to optimal surveillance strategies and the resultant variation in practice. Finally, we introduce an ongoing Medical Research Council (MRC) randomised controlled trial (RCT), the Trial of Imaging and Schedule in Seminoma Testis (TRISST), designed to address knowledge gaps and pave the way for a standardised approach.