Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial

@article{Oliver2005RadiotherapyVS,
  title={Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial},
  author={R. Timothy D. Oliver and Mark Mason and G. M. Mead and Hans von der Maase and G. J. S. Rustin and J. K. Joffe and Ronald de Wit and Nina Aass and J. Graham and Robert Coleman and S J Kirk and S. P. Stenning},
  journal={The Lancet},
  year={2005},
  volume={366},
  pages={293-300}
}
BACKGROUND Adjuvant radiotherapy is effective treatment for stage I seminoma, but is associated with a risk of late non-germ-cell cancer and cardiovascular events. [...] Key MethodMETHODS Between 1996 and 2001, 1477 patients from 70 hospitals in 14 countries were randomly assigned to receive radiotherapy (para-aortic strip or dog-leg field; n=904) or one injection of carboplatin (n=573; dose based on the formula 7x[glomerular filtration rate+25] mg), at two trial centres in the UK and Belgium.Expand
Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214).
  • R. Oliver, G. Mead, +6 authors S. Stenning
  • Medicine
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2011
TLDR
These updated results confirm the noninferiority of single dose carboplatin (at 7 × AUC dose) versus RT in terms of RFR and establish a statistically significant reduction in the medium term of risk of second GCT produced by this treatment.
Adjuvant Carboplatin Treatment in 115 Patients With Stage I Seminoma: Retrospective Multicenter Survey.
TLDR
Adjuvant AUC 7 carboplatin reduce relapses of stage I seminoma patients to 5.2%, with manageable toxicities, and dose reductions should be proscribed.
Treatment of stage I seminoma: is it time to change your practice?
TLDR
Results of this MRC trial led its investigators to conclude that one cycle of carboplatin was equivalent in safety and efficacy and less toxic than RT, and Carboplatin is not yet a standard of care.
Late Relapse of Stage I Seminoma following Single-Agent Carboplatin
TLDR
A patient who received adjuvant carboplatin for stage 1 seminoma and relapsed with abdominal lymph node metastasis at 48 months is presented, highlighting that late relapse can occur, and it is suggested that CT surveillance beyond 2 years is required given the lack of mature data on late relapse.
Adjuvant Radiotherapy Outcome of Stage I Testicular Seminoma: A Single Institution Study
TLDR
Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure and an increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction.
Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma
TLDR
It must be remembered that 80-85% of patients with testicular seminoma require no treatment after orchiectomy, and the long-term side effects of any adjuvant treatment approach must be carefully considered.
The long-term risks of adjuvant carboplatin treatment for stage I seminoma of the testis.
TLDR
This study addresses some of the concerns surrounding the long-term safety of single-agent carboplatin in the management of stage I seminoma of the testis and helps in planning long- term follow-up for patients receiving this form of treatment.
Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study.
TLDR
Chemotherapy is a highly effective and well-tolerated treatment for patients with stage IIA or IIB seminoma and represents an available alternative that could avoid some of the serious late effects associated with radiotherapy.
Controversies in the management of clinical stage I testicular seminoma
TLDR
ACT seems to be adequate treatment for patients with high-risk of relapse, as well as AS for those with low- risk of relapse in patients with CSI testicular seminoma.
Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up.
TLDR
This large and mature dataset from three randomized trials has provided support for the use of either radiation therapy or carboplatin therapy as adjuvant treatment for stage I seminoma.
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One adjuvant course of carboplatin was associated with low myelotoxicity and low gonadal toxicity; however, the recurrence rate was almost 9% and thus unsatisfactory; therefore, the two-course regimen ofcarboplatin appears to be equivalent to radiotherapy.
Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study.
TLDR
From an oncologic standpoint, two cycles of carboplatin monotherapy was highly effective and very well tolerated by all patients and was associated with only mild gastrointestinal side effects.
Pilot studies of 2 and 1 course carboplatin as adjuvant for stage I seminoma: should it be tested in a randomized trial against radiotherapy?
TLDR
A retrospective quality of life questionnaire reviewing the incidence of early and late toxicity revealed no major differences though they suggest that those treated with one course adjuvant carboplatin had somewhat less sickness and an earlier return to work.
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  • Medicine
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2005
TLDR
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TLDR
If the recurrence rate remains as low as after adjUvant radiotherapy, which should be proved in a phase III study, single-agent carboplatin therapy will be an alternative adjuvant approach for clinical stage I seminoma.
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TLDR
A radomised trial is now justified to assess the quality of life and late toxicity of this approach compared with prophylactic radiotherapy as well as the effect of 2 courses of adjuvant carboplatin.
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TLDR
It is suggested that two adjuvant courses of single-agent carboplatin for clinical stage I seminoma patients might be equivalent to radiotherapy.
Metastatic seminoma treated with either single agent carboplatin or cisplatin-based combination chemotherapy: a pooled analysis of two randomised trials
To study the role of single agent carboplatin chemotherapy in patients with metastatic seminoma based on the data from two randomised trials. In subgroup analyses in patients with different disease
Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma.
TLDR
This dual treatment policy is feasible in a multicenter setting and preserves 70% of patients from adjuvant chemotherapy and single-agent carboplatin is effective in reducing the relapse rate in patients with high-risk stage I seminoma.
Pooled analysis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage 1 seminoma
TLDR
10 and 20 year follow up experience is reported from the phase 2 studies of 1 and 2 course carboplatin that preceeded the randomised trial suggesting that 1 coursecarboplatin was equally effective but also in the short term was associated with significantly less tumours in the contrateral testis.
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