NEW YORK (Reuters Health), Jun 4 - In men with surgically resected stage I seminoma, a single dose of carboplatin chemotherapy is as effective as two to three weeks of radiation therapy in preventing recurrence and is much less toxic, according to study findings presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago.
Testicular cancer is the most frequent cancer in men age 15 to 45 years, and surgery followed by radiation has been the standard of care, study leader Dr. Tim Oliver of St. Bartholomew's Hospital in London noted at the conference.
"With this study, we fairly solidly confirmed" that single-dose carboplatin is an effective treatment in patients with early-stage seminoma, he added.
In the study, 573 patients were randomized to a single dose of carboplatin given over one hour on an outpatient basis, and 904 patients were randomized to a course of daily radiotherapy given over two or three weeks.
At five years, the rate of relapse was similar in the two treatment arms -- 5% in the carboplatin arm and 4% in the radiation arm, Oliver reported.
"Quite unexpectedly," Oliver reported, "we found that there was a 78% reduction -- a hazard ratio of 0.22 and p-value of 0.03 -- in the number of tumors in the remaining testicle," after a median follow up of 6.5 years.
Fifteen patients in the radiation arm developed contralateral testicular germ cell cancers versus two patients in the carboplatin arm. One patient in the radiation arm died of seminoma versus none in the chemotherapy arm.
Adverse effects were low with both treatments, although patients treated with radiation reported higher levels of moderate to severe lethargy (24% versus 7% for carboplatin) four weeks after starting treatment.
"Personal preference is becoming a more important factor in determining the best treatment for patients with testicular cancer. We've also seen this in prostate cancer, where there are a number of equally strong treatment options," Oliver noted in a written statement.
"This study establishes surgery followed by carboplatin chemotherapy as a safe new alternative for patients who have early-stage seminoma and would prefer a treatment that lasts a shorter period of time," he added.
By Megan Rauscher
Last Updated: 2008-06-03 16:05:19 -0400 (Reuters Health)
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