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Am J Clin Oncol. 2013 Oct;36(5):500-4. doi: 10.1097/COC.0b013e318254950a.

Overall survival analysis of adjuvant radiation versus observation in stage I testicular seminoma: a surveillance, epidemiology, and end results (SEER) analysis.

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  • 1*Radiation Oncology Branch, National Cancer Institute, Bethesda, MD Departments of ‡Medical Oncology ¶Radiation Oncology, Cancer Care Northwest, Spokane †University of Washington School of Medicine, Seattle, WA Departments of §Radiation Oncology ∥Health Sciences Research, Mayo Clinic, Rochester, MN #Department of Radiation Oncology, Huntsman Cancer Institute, the University of Utah Medical Center, Salt Lake City, UT **Texas Oncology, Baylor-Irving Cancer Center, Irving, TX.

Abstract

OBJECTIVE:

The standard adjuvant treatment for men with stage I testicular seminoma remains controversial within the literature. We analyzed survival rates in men with stage I seminoma who underwent adjuvant radiation therapy (RT) or observation (OB) after orchiectomy.

METHODS:

Data were obtained from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute from 1973 to 2003. The primary end points were overall survival (OS) and cause-specific survival (CSS). Multivariate Cox regression models were used to study the significance of clinical variables: age at diagnosis, laterality of primary disease, race, and radiation group.

RESULTS:

Of 6764 patients eligible for analysis, 5265 were treated with RT and 1499 with OB. After a median follow-up of 7.6 years, the 5-, 10-, and 20-year OS rates for the RT versus OB were 97.9 versus 95.0, 94.8 versus 92.2, and 83.5 versus 84.1 (P=0.0047), respectively. The CSS rates for the same time periods were 99.6 versus 98.7, 99.4 versus 98.7, and 99.2 versus 98.7 (P=0.0015), respectively. Adjuvant RT was associated with improved CSS on multivariate analysis with hazard ratio of 0.37 (confidence interval, 0.20-0.70; P=0.0023).

CONCLUSIONS:

Within this large US population analysis, adjuvant RT was associated with improved OS and CSS compared with OB for men with stage I testicular seminoma. Further studies are needed to determine whether modern RT techniques and field-size reductions may lead to greater improvements in the therapeutic ratio, in light of the trend toward chemotherapy as primary treatment.

PMID:
22781383
[PubMed - indexed for MEDLINE]
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