SINGLE DOSE CARBOPLATIN THERAPY FOR STAGE 1 SEMINOMA TESTIS

A 32 year old gentleman presented to us with painless  testicular mass.He had normal tumor markers.

He was taken up for high inguinal orchiectomy. The final histopathological report showed the mass to be seminoma.

His PET-CT was normal.We gave him three options for further treat( as the staging was stage 1 seminoma):

1) Radiotherpy

2) Single dose carboplatin chemotherpy

3)Active surveillance

The single dose chemotherapeutic regimen was  finally given to the patient after he agreed for the same.We explained him the pros and cons of all the modalities.

SINGLE DOSE CHEMOTHERAPY FOR STAGE 1 SEMINOMA:

Traditionally radiotherapy has been routinely given for the patients of stage 1 seminoma. But there are many concerns about the radiotherapy:

1) about 1/3 of the relapses are outside the radiotherapy field

2)The cardiovascular side effects

3)the likely hood of recurrence of non germ cell cancer

Active surveillance is a good option to avoid the side effects of radiotherapy but is associated with 15-20% relapse rate.Many patients are somewhat dissatisfied about " no adjuvant therapy" and live under fear.It also needs dedicated follow-up.

But the single dose chemotherapy appears appealing ( as its adjuvant therapy and convenient also).There was a randomised trial conducted by Oliver et al..

Around 1477 patients were enrolled for radiotherapy and single dose chemotherapy by carboplatin  ( 1996 -2001 from 70 hospitals in 14 countries).The groups were followed up for 4 years.The relapse rate in bothe the groups were comparable.It was also interesting to see the group which received carboplatin were less lethargic and took less time off from daily  day to day activities.As most of the patients with    carcinoma testis are young; professional work related issues hold a lot of importance in their life.  

 

A single dose of carboplatin appears to be as effective as adjuvant radiotherapy in preventing disease recurrence among men with stage 1 seminoma after orchiectomy. In an abstract presented here at the American Society of Clinical Oncology (ASCO) 44th Annual Meeting, researchers reported that carboplatin was also significantly more effective than radiotherapy in preventing contralateral testicular germ-cell cancers.