Options for stage I seminoma testicular cancer include surveillance, radiotherapy or carboplatin.
Clinical stage I (CS I) seminoma has been the subject of various studies aimed at finding the ideal treatment. Due to its high radiosensitivity, radiotherapy has been the standard approach for decades. However, the fact that CS I seminoma has a recurrence rate of only 15-20% has prompted many suggestions for better treatment stratification offering surveillance therapy for a subgroup of patients. Moreover, carboplatinum-based monochemotherapy has been the topic of various retrospective studies demonstrating equal effectiveness for adjuvant chemotherapy with one cycle of carboplatin. Carboplatin ahs been coing into wider use for adjuvant therapy. Consensus suggests that adjuvant chemotherapy reduces the risk of relapse compared with surveillance, but that it is associated with immediate adverse effects (nausea, diarrhoea, and indigestion) and possible long-term risks of reduced fertility and development of secondary malignancies.
With surveillance most people can avoid the toxicity of adjuvant treatment but they must face the uncertainty of relapse as well as regular hospital follow up for as long as 10 years. Adjuvant radiotherapy and adjuvant chemotherapy can both substantially reduce the risk of relapse, but both are associated with mild immediate toxicity. Radiotherapy is also associated with a low but difficult to quantify long term risk of second malignancy and reduced fertility. The pattern of relapse also differs after adjuvant radiotherapy or chemotherapy. After radiotherapy, relapse in pelvic nodes, mediastinum, or supraclavicular area is most common. After chemotherapy, relapse is most common in the para-aortic nodes. Seminoma is a radio-sensitive tumour, and the current standard treatment for stage 1 seminoma is orchidectomy followed by infradiaphragmatic lymph node irradiation or two courses of carboplatin.
Oliver RTD, Mason MD, Mead GM, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomized trial. Lancet 2005;366:293-300
nccn.org, testicular cancer 2014
P. Albers (chairman), W. Albrecht, F. Algaba,C. Bokemeyer, G. Cohn-Cedermark, K. Fizazi,
A. Horwich, M.P. Laguna, Guidelines onTesticularCancer, http://www.uroweb.org/gls/pdf/10_Testicular_Cancer.pdf