Genitourinary Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_23_2356 - Stage 1 Testicular Seminomas Treated with Single Cycle Carboplatin: Outcomes and Management of Relapse- A Single-Centre Experience.

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Stage 1 Testicular Seminomas Treated with Single Cycle Carboplatin: Outcomes and Management of Relapse- A Single-Centre Experience.
H. Kirk, A. Challapalli, J. Braybrooke, and A. Bahl; Bristol Cancer Institute, Bristol, United Kingdom

Purpose/Objective(s): Stage 1 testicular seminomas have an excellent prognosis, with nearly 100% disease specific survival. The options of treatment for Stage 1 disease include orchidectomy followed by (i) surveillance, (ii) radiotherapy (RT) to the paraaortic (PA) nodes or (iii) a single cycle of Carboplatin. Single cycle of Carboplatin is the standard of care in our institution. We sought to analyse the outcomes of patients who received single cycle carboplatin post-orchiectomy.

Materials/Methods: We conducted a retrospective cohort analysis of all patients with a diagnosis of stage 1 testicular seminoma who received single-agent carboplatin, area under the curve =7 mg.min/ml (AUC 7), between July 2011 to July 2017. Patient lists were generated from our electronic chemotherapy prescribing system, Chemocare, and our RT information system, MOSAIQ. Further data was obtained from electronic records of patient consultations, tumour marker serology (AFP and HCG), pathology reports and imaging. The age of the patients, duration of follow up, relapse rates, site of relapse and subsequent treatment were recorded.

Results: Ninety-six patients with Stage 1 testicular seminoma were treated with a single cycle of carboplatin (AUC 7), following inguinal orchidectomy, between July 2011 and July 2017. The median age was 40 years (range 21-75 years). The median follow up time was 56 months (range 3-78 months). Five patients have relapsed, with the median time to relapse being 24 months (range 12-72 months). The cumulative incidence estimate of relapse was 5.2% at 24 months. All 5 patients relapsed in the para-aortic (PA) region (2 x <2cm, 3x 2-5cm), picked up on surveillance imaging. AFP and HCG were not elevated at time of relapse. One patient who relapsed within a year was salvaged with RT to the PA lymph nodes. The four patients who relapsed beyond a year received a further cycle of carboplatin (AUC7) followed by RT to PA nodes. RT was limited to the PA field in all cases. 4 patients received 30Gy in 15# and 1 patient received 36Gy in 18# in 2 phases. None of the five patients have had a further relapse since RT (median follow-up time 12 months (range 8 to 24 months). RT was well tolerated with only one patient requiring brief supportive care for Grade 2 vomiting during treatment. Of the remaining four patients, 2 had no toxicities to report, one had Grade 1 fatigue and one had Grade 1 fatigue and nausea. All symptoms were self-limiting. There have been no reported late adverse effects.

Conclusion: The overall outcome of patients with stage 1 seminoma treated with Carboplatin, mirrors that of clinical trials. Our data demonstrates that the PA nodal relapses can be successfully salvaged with a combination of Carboplatin and RT, with minimum morbidity. This combination strategy should be considered as optimal regime for salvage. As all relapses were diagnosed radiologically whilst tumour markers remained unremarkable throughout, imaging surveillance is crucial.

Author Disclosure: H. Kirk: None. A. Challapalli: None. J. Braybrooke: None.

Send Email for Amarnath Challapalli


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Send Email for Stage 1 Testicular Seminomas Treated with Single Cycle Carboplatin: Outcomes and Management of Relapse- A Single-Centre Experience.