RESULTS OF A POLICY OF SURVEILLANCE IN STAGE-I TESTICULAR SEMINOMA

Purpose: To determine what proportion of patients with Stage I testicu lar seminoma will be cured with orchidectomy alone. Methods and Materi als: From August 1984 to December 1991 148 patients with Stage I testi cular seminoma were entered on a prospective study of surveillance fol lowing orchidectomy. The eligibility criteria included a normal chest X ray, lymphogram, computed tomography (CT) of the abdomen and pelvis, and normal post-orchidectomy tumor markers (AFP and BHCG). Patients w ere followed with a clinical assessment (markers, chest X ray and CT a bdomen and pelvis) at 4 to 6 monthly intervals. Results: With a median follow-up of 47 months (range 7-87 months), the actuarial relapse-fre e rate was 81% at 5 years. Twenty-three patients have relapsed with a median time to relapse of 15 months (range 2-61 months). Four patients (17%) relapsed at 4 or more years from diagnosis. Twenty-one of the 2 3 relapses occurred in the paraaortic lymph nodes, one patient relapse d in the mediastinum and ipsilateral inguinal nodes and one patient ha d an isolated ipsilateral inguinal node relapse. Nineteen patients wer e treated for relapse with external beam radiation therapy of which th ree developed a second relapse and were salvaged with chemotherapy. Fo ur patients were treated for first relapse with chemotherapy and one d eveloped a second relapse and died of disease. Age at diagnosis was th e only prognostic factor for relapse, with patients age less-than-or-e qual-to 34 having an actuarial relapse-free rate at 5 years of 70% in contrast to a 91% relapse-free rate in those > 34 years of age. Conclu sion: We recommend that surveillance in Stage I testicular seminoma sh ould only be performed in a study setting until further data regarding the risk of late relapse and the efficacy of salvage chemotherapy is available.