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June 7, 2004
Stage I seminoma is an early stage, slow-growing type of testicular cancer. The standard treatment is usually removal of the cancerous testicle (orchiectomy), followed by adjuvant radiation therapy. However, patients who receive radiation therapy also tend to have a higher risk of developing a second cancer in another organ 10 to 20 years later.
Results of a new European study show that one course of chemotherapy treatment with carboplatin (Paraplatin) is as effective as radiation therapy, and is associated with a lower risk of a second cancer in the near term. In men who are at risk for developing cancer in the remaining testicle, this research suggests that the use of chemotherapy may allow doctors to preserve the remaining testicle.
Doctors randomly assigned 904 patients with stage I seminoma to receive radiation after surgery, and 543 patients to receive a single dose of carboplatin after surgery. After two years of follow-up, the researchers found that cancer did not return in 98.1% of patients who received carboplatin treatment, compared with 97.2% of the patients who received radiation treatment. These numbers were also similar after three years of follow-up. To date, one man who received carboplatin has developed a tumor in the remaining testicle, compared with seven men who received radiation therapy.
"This large, randomized trial establishes after 20 years of research and uncertainty that one shot carboplatin in the short term is as safe as radiation, is less toxic, and might open the way to using chemotherapy for testis conservation," said lead author R. Timothy Oliver, MD, Sir Maxwell Professor in Oncology at Barts and The London Queen Mary's School of Medicine in Great Britain.
Another advantage is that patients only need one chemotherapy treatment instead of three weeks of radiation therapy, which is more convenient for the patient and results in a shorter recovery time. Because these patients have only been followed for two or three years, researchers do not yet know the long-term effects of this therapy.
"Though needing longer follow-up and larger numbers to be sure, this surprising finding is the first hint that ultimately research may make it possible for testis conservation to be as routine as breast conservation," said Dr. Oliver.
What This Means For Patients
Although testicular cancer is curable, men may experience second cancers or other long-term effects from radiation therapy. Because many men who develop testicular cancer are young, the possibility of long-term side effects is a significant issue. These data may introduce adjuvant chemotherapy as the new standard treatment for stage I seminoma, but the long-term risks of this treatment are not known at this time. Adjuvant chemotherapy also appears to be safer and more convenient for patients than adjuvant radiation therapy. The study did not evaluate this treatment in men with testicular nonseminomas.