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Treatment options in patients with stage I seminoma
Treatment
options in patients with stage I seminoma include radiotherapy (RT),
surveillance, and adjuvant chemotherapy. The relapse rates differ between
the 3 approaches -
surveillance (15%), RT (5%) and adjuvant chemotherapy (2%-8%). The
available data suggest that almost 100 percent of patients are cured
whichever approach is chosen as post-orchidectomy management. However,
there is increasingly persuasive data that adjuvant RT in this setting is
associated with a small but definite increased risk of second malignancy
and cardiovascular death. In addition, the long-term data from
surveillance series have documented the safety of this approach. While, adjuvant retroperitoneal RT was the standard of care for the past
50-60 years, it is now accepted that a policy of surveillance provides the
optimal outcome, minimizing the burden of treatment while maintaining the
cure rate at virtually 100%. Adjuvant RT remains a viable treatment option
for those unable to follow a surveillance protocol.
Adjuvant chemotherapy should be restricted to study settings as long term
data on outcome is not available.
Bibliographical reference: Chung P, Warde P: "Surveillance in stage I testicular seminoma", Urol Oncol. 2006 Jan-Feb;24(1):75-9
Padraig
Warde
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