Related Pages Clinical Trial Search NCI's PDQ® registry of cancer clinical trials. Testicular Cancer Home Page NCI's gateway for information about testicular cancer. Highlights from ASCO 2004 (Posted: 06/05/2004, Reviewed: 12/06/2005) - A collection of links to material summarizing some of the important clinical trial results announced at the 2004 annual meeting of the American Society of Clinical Oncology (ASCO).

Keywords

Testicular cancer, seminoma, carboplatin, radiation therapy. (Definitions of many terms related to cancer can be found in the Cancer.gov Dictionary.)

Summary

One shot of carboplatin appeared to be as effective as radiation therapy in treating early seminoma, a kind of testicular cancer, and also appeared safer, reducing the risk of second cancers. Further follow-up is needed to show whether the benefits last.

Source

The Lancet, July 23, 2005 (see the journal abstract).

Background

Radiation therapy cures the vast majority of early-stage seminomas but increases the risk of second cancers in organs such as the stomach, bladder, colon, rectum, and possibly the pancreas. Seminoma accounts for about 30 percent of all testicular cancers.

The Study

Between 1996 and 2001, researchers in the United Kingdom and Belgium enrolled 1,477 patients with stage I seminoma. The patients were randomly divided into two groups. One group received radiation therapy while the other received one injection of carboplatin.

The study’s research team was led by R. Timothy Oliver, M.D., of St. Bartholomews Hospital in London (see the protocol summary.) Results were originally presented at the American Society of Clinical Oncology (ASCO) annual meeting in June 2004.

Results

Patients have been followed for a median of four years. The rates of cancer recurrence and second cancers were comparable between the two groups. About 97 percent of the radiation group and 98 percent of the carboplatin group were cancer free after two years. After three years, about 96 percent in the radiation group and 95 percent in the carboplatin group were cancer free.

With median follow-up now at four years, there have been 32 recurrences of the original tumor in the radiation group compared to 27 in the carboplatin group. Second cancers have occurred in three patients who received carboplatin compared to 11 patients who received radiation. Only one tumor has developed in the remaining testis in the carboplatin group compared with seven in the radiation group.

Limitations

In an accompanying editorial, radiation oncologists Padraig Warde, M.D., and Mary Gospodarowicz, M.D., of the University of Toronto in Ontario, Canada, wrote, "Whilst the results from this study confirm the benefit of carboplatin in stage I seminoma, we are not sure that adjuvant chemotherapy represents the best management strategy in this situation." The median follow-up is short, they wrote, and further relapses might occur in the carboplatin-treated group. In addition, the long-term side effects of carboplatin remain unknown.

Comment

“These are encouraging results,” said Wyndham Wilson, M.D., of the National Cancer Institute’s Center for Cancer Research. “They suggest that carboplatin may be safer than radiation” in terms of the risk of second cancers. With further follow-up, the difference between the trial’s two arms may become even greater, he added, “in that the risk of second cancer from radiation increases with time, out to 25 years and beyond.”

The finding that cancers in the remaining testis were reduced is seen as especially encouraging. “Though we need longer follow-up and larger numbers to be sure, this surprising finding is the first hint that research may ultimately make it possible for testis conservation to be as routine as breast conservation,” said Oliver.

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