ASTRO Patient Summary: Surveillance Should Be the Standard Approach in Patients with Stage I Seminoma
Stage I testicular cancer (seminoma) is managed by first-line surgery (orchiectomy) and then, most commonly, observation without additional therapy. Many centers offer these patients radiation as added protection, with little data to back up this therapy. Radiation therapy is not without side effects, which include: decreased fertility, increased risk of cardiac disease, and increased risk of a second cancer. This study looked back at the records (called a retrospective study) of 704 patients over a 22-year period at Princess Margaret Hospital in Canada. 421 patients were managed with observation and 283 were treated with radiation. Because the groups differ in size, one cannot look at the number of patients that relapsed alone. The authors calculated that the risk of requiring chemotherapy at some point during the 10 years after surgery was 4.6% for the observation group vs. 3.9% for the radiation group. This difference is not significant, and given the additional risks involved with radiation, the authors propose observation as standard of care. The reviewer points out an issue with retrospective studies – the patients are not randomly assigned to receive the treatment. It is possible that the physicians caring for the patients steered those they felt to be at higher risk into the radiation group, therefore making it difficult to apply these results to the general stage I patient population. The researcher suggests further research is needed.