Single dose of chemotherapy as effective as radiation therapy for early-stage testicular cancer
The first randomised trial to evaluate the long-term outcome of treatment with a single dose of chemotherapy for early-stage testicular tumours has found that the approach is safe, effective and less toxic compared to radiation therapy, the current standard of care. The study, the largest ever in testicular cancer, also showed that after five years, patients receiving chemotherapy had a decreased risk of developing a second tumour in the other testicle, though longer follow-up is needed.
Testicular cancer is the most common solid tumour diagnosed in men between the ages of 15 and 35. There are about 8,000 new cases in the United States each year, and most are curable with surgery followed by radiation. All patients in the study had a type of tumour called seminoma, which makes up about half of all testicular cancers, and were first treated with surgery to remove the affected testicle.
Patients were randomised to receive either a single dose of the chemotherapy drug carboplatin given over one hour on an outpatient basis (573 patients) or a course of daily radiation therapy given for two or three weeks (904 patients). The dose of carboplatin varied and was based on each patient's kidney function. After five years, the rate of cancer recurrence was comparable in both arms - 5 percent of patients in the chemotherapy group and 4 percent of patients in the radiation therapy group. With a median follow-up of 6.5 years, patients who received carboplatin were 78 percent less likely to develop a tumour in the remaining testicle (15 patients in the radiation therapy arm versus two patients in the carboplatin arm). One patient in the radiation therapy arm died of seminoma, versus none in the chemotherapy arm. The side effects for both treatments were low, although those in the radiation therapy group reported higher levels of moderate or severe lethargy (24 percent vs. 7 percent for patients receiving 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," said Tim Oliver, MD, professor emeritus of medical oncology at St. Bartholomew's Hospital in London and the study's lead author. "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."
The researchers said that future studies will investigate the option of lumpectomy and single dose carboplatin for men who present early enough with small tumours, allowing them to avoid losing the diseased testicle.
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