Stage I seminoma: Surveillance is often sufficient

Surveillance for cancer recurrence, rather than additional chemotherapy or radiation therapy, is sufficient for the vast majority of men who have undergone successful surgery for stage I seminoma, a long-term study suggests.

Researchers found that 99.6% of patients who underwent surveillance only were alive 10 years after their initial diagnosis.

“To our knowledge, this study is the largest to address this issue in patients with stage I seminoma, and with the longest follow-up. Now we have solid proof that surveillance is safe and appropriate for most patients with this particular cancer,” said first author Mette Saksø Mortensen, MD, a PhD student at the Copenhagen University Hospital in Copenhagen, Denmark.

“We also characterized key prognostic factors for relapse, which can help us identify ‘high-risk’ patients who may need adjuvant therapy instead of surveillance. However, in general, seminoma stage I patients can safely be followed on a surveillance program.”

Study results will be presented later this week at the American Society of Clinical Oncology annual meeting in Chicago.

Using a nationwide clinical database, researchers identified 1,822 patients with stage I seminoma followed on a 5-year surveillance program in Denmark. By linking the patient files with national registries, they were able to follow the patients for a median period of 15.4 years. All patients had initial surgery to treat their primary cancer. Overall, 355 of 1,822 patients (19.5%) experienced a relapse, which was treated with radiotherapy (216 patients), chemotherapy (136 patients), or surgery (3 patients). The 10-year cancer-specific survival was 99.6%, reported Dr. Mortensen, who worked on the study with Gedske Daugaard, MD, and colleagues.

Researchers found that tumor size larger than 1.5 inches, spread to blood or lymphatic vessels, and elevated levels of human chorionic gonadotropin increased the risk of relapse. These factors had been associated with high-risk patients in prior, smaller studies.

“This important study is one of several recent reminders that sometimes ‘less is more’ in patient care,” said ASCO President-Elect Clifford A. Hudis, MD, of Memorial Sloan-Kettering Cancer Center, New York. “Opting for surveillance spares patients, most of whom are young men, from the harmful side effects of chemotherapy and radiation without diminishing their chances for a long and healthy life.”