Abstract
Context
The extent and duration of routine follow-up after paraaortic (PA) radiotherapy for stage I seminoma remain controversial in terms of efficacy, costs of technical investigations and long-term morbidity.
Objective
To analyze the current literature assessing routine follow-up after PA radiotherapy for stage I seminoma.
Evidence acquisition
We identified all published reports on PA radiotherapy for stage I seminoma (1986–2005). We analyzed time patterns of recurrence, sites and methods of detection of relapse, and follow-up programs used.
Evidence synthesis
We identified 11 publications reporting outcome in 2,280 patients. Median time to recurrence in 80 relapsing patients was 15.5 months. Less than 10% of recurrences were diagnosed beyond the third year of follow-up. Isolated locoregional or distant recurrence was observed in 52 and 20 patients, respectively, without significant difference in median time to relapse. 19 out of 43 recurrences with reported method of detection of relapse were diagnosed by routine technical investigations. There was no significant difference in time to relapse between those patients followed with low volume as compared to high-volume imaging protocols.
Conclusions
Our data suggest that technical investigations in posttreatment surveillance should be restricted to the first 3 years of follow-up. Furthermore, surveillance programs with a high volume of imaging apparently do not lead to earlier detection or less advanced stage at the time of relapse as compared to protocols with low volume imaging.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Albers P, Albrecht W, Algaba F et al (2005) Guidelines on testicular cancer. Eur Urol 48:885–894
Bamberg M, Schmidberger H, Meisner C et al (1999) Radiotherapy for stage I, IIA/B testicular seminoma. Int J Cancer 83:823–827
Bruns F, Bremer M, Meyer A et al (2005) Adjuvant radiotherapy in stage I seminoma: is there a role for further reduction of treatment volume? Acta Oncol 44:142–148
Brunt AM, Scoble JE (1992) Para-aortic irradiation for early stage testicular seminoma. Clin Oncol l4:165–170
Buchholz TA, Walden TL, Prestidge BR (1998) Cost-effectiveness of posttreatment surveillance after radiation therapy for early stage seminoma. Cancer 82:1126–1133
Claßen J, Souchon R, Hehr T et al (2001) Treatment of early stage testicular seminoma. J Cancer Res Clin Oncol 127:475–481
Classen J, Schmidberger H, Meisner C et al (2004) Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer 90:2305–2311
Claßen J, Souchon R, Schmidberger H et al (2005) Is follow-up necessary after adjuvant radiotherapy for testicular seminoma? Results of a prospective trial in 675 patients. Strahlenther Onkol 181(Suppl 1):61 (Abstr)
Classen J, Schmidberger H, Souchon R, Weissbach L, Hartmann M, Hartmann JT, Hehr T, Bamberg M (2009) What is the value of routine follow-up in stage I seminoma after paraaortic radiotherapy? An analysis of the German Testicular Cancer Study Group (GTCSG) in 675 prospectively followed patients. Strahlenther Onkol (accepted)
Fossa SD, Horwich A, Russel JM et al (1999) Optimal planning target volume for stage I testicular seminoma: a Medical Research Council randomized trial. J Clin Oncol 17:1146–1154
Harvey ML, Geldart TR, Duell R et al (2002) Routine computerised tomographic scans of the thorax in surveillance of stage I testicular non-seminomatous germ-cell cancer—a necessary risk? Ann Oncol 13:237–242
Jones WG, Fossa SD, Mead GM et al (2005) Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: a report on Medical Research Council trial TE18, European Organization for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 23:1200–1208
Kakehi Y, Kamoto T, Kawakita M et al (2002) Follow-up of clinical stage > I testicular cancer patients: cost and benefit considerations. Int J Urol 9:154–160
Kiricuta IC, Sauer J, Bohndorf W (1996) Omission of the pelvic irradiation in stage I testicular seminoma: a study of postorchiectomy paraaortic radiotherapy. Int J Radiat Oncol Biol Phys 35:293–298
Kopp HG, Kuczyk M, Classen J et al (2006) Advances in the treatment of testicular cancer. Drugs 66:641–659
Krege S, Beyer J, Souchon S et al (2008a) European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 53:478–496
Krege S, Beyer J, Souchon S et al (2008b) European Consensus Conference on Diagnosis and Treatment of Germ Cell Cancer: A Report of the Second Meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part II. Eur Urol 53:497–513
Livsey JE, Taylor B, Mobarek N et al (2001) Patterns of relapse following radiotherapy for stage I seminoma of the testis: implications for follow-up. Clin Oncol 13:296–300
Logue JP, Harris MA, Livsey JE et al (2003) Short course para-aortic radiation for stage I seminoma of the testis. Int J Radiat Oncol Biol Phys 57:1304–1309
Mead GM, Fosså SD, Oliver RT et al (2008) Relapse patterns in 2,466 stage 1 seminoma patients (pts) entered into Medical Research Council randomised trials. J Clin Oncol 26(Suppl): 5020 (Abstr)
Melchior D, Hammer P, Fimmers R et al (2001) Long term results and morbidity of paraaortic compared with paraaortic and iliac adjuvant radiation in clinical stage I seminoma. Anticancer Res 21:2989–2994
Niazi TM, Souhami L, Sultanem K et al (2005) Long-term results of para-aortic irradiation for patients with stage I seminoma of the testis. Int J Radiat Oncol Biol Phys 61:741–744
Niewald M, Waziri A, Walter K et al (1995) Low dose radiotherapy for stage I seminoma: early results. Radiother Oncol 37:164–166
Oliver RTD, Mason MD, Mead GM et al (2005) Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomized trial. Lancet 366:293–300
Read G, Johnston RJ (1993) Short duration radiotherapy in stage I seminoma on the testis: preliminary results of a prospective study. Clin Oncol 5:364–366
Sedlmayer F, Joos H, Deutschmann H et al (1999) Long-term tumor control and fertility after para-aortic limited radiotherapy of stage I seminoma. Strahlenther Onkol 175:320–324
Sharda NN, Kinsella TJ, Ritter MA (1996) Adjuvant radiation versus observation: a cost analysis of alternate management schemes in early-stage testicular seminoma. J Clin Oncol 14:2933–2939
Souchon R, Schmoll HJ, Krege S (eds) (2002) Guidelines for diagnosis and treatment of testis cancer on the basis of evidence-based medicine (EBM) [German Testicular Cancer Study Group]. Qualitätssicherung in der Onkologie, 1st edn. München Bern Wien New York, Zuckschwerdt
Spermon JR, Witjes JA, Kiemeney LA (2004) Efficacy of routine follow-up after first-line treatment for testicular cancer. World J Urol 22:235–243
Sultanem K, Souhami L, Benk V et al (1998) Para-aortic irradiation only appears to be adequate treatment for patients with stage I seminoma of the testis. Int J Radiat Oncol Biol Phys 40:455–459
Taylor MB, Carrington BM, Livsey JE et al (2001) The effect of radiotherapy changes on site of relapse in stage I testicular seminoma. Clin Oncol 56:116–119
Trigo MJ, Tabernero JM, Paz-Ares L et al (2000) Tumor markers at the time of recurrence in patients with germ cell tumors. Cancer 88:162–168
Willich N, Wendt T, Rohloff R et al (1986) Zur Strahlentherapie des Seminoms: kleinvolumige Bestrahlung im Stadium pT1N0M0–prophylaktische Mediastinalbestrahlung. Strahlenther Onkol 162:735–741
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Claßen, J., Souchon, R., Hehr, T. et al. Posttreatment surveillance after paraaortic radiotherapy for stage I seminoma: a systematic analysis. J Cancer Res Clin Oncol 136, 227–232 (2010). https://doi.org/10.1007/s00432-009-0653-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-009-0653-x