Postsurgical management of stage I testicular seminoma

AFP: alpha-fetoprotein; beta-hCG: beta-human chorionic gonadotropin; CT: computed tomography; CXR: chest plain film radiograph; LDH: lactate dehydrogenase; MRI: magnetic resonance imaging; OS: overall survival; RT: radiation therapy.

* Surveillance involves history, physical exam, and serial radiographic imaging. Tumor marker surveillance is optional.

• A CXR should be performed only if clinically indicated. A contrast-enhanced CT of the chest is preferred in patients with symptoms concerning for disease recurrence.
• History, physical exam, and tumor markers (AFP, beta-hCG, and LDH) every 3 to 6 months in year 1, every 6 months in year 2, every 6 to 12 months in year 3, and then annually in years 4 and 5.
• Contrast-enhanced CT or MRI of the abdomen and pelvis at 4 to 6 months after orchiectomy, and 12 months in year 1, every 6 months in year 2, every 6 to 12 months in year 3, and every 12 to 24 months in years 4 and 5.

¶ Adjuvant carboplatin is associated with a lower risk of cardiovascular disease compared with adjuvant RT. However, adjuvant carboplatin may delay rather than prevent the long-term development (>10 years) of contralateral testis cancer. In addition, tumors that relapse after adjuvant carboplatin are also more likely to be resistant to further cisplatin-based therapy.

Δ The total dose for adjuvant RT is 20 Gy in 10 daily fractions. Adjuvant RT is associated with increased risk of cardiovascular disease and second malignancies.

◊ Patients may receive either one or two cycles of adjuvant carboplatin, but the optimal number of cycles is not established. Some UpToDate contributors prefer two cycles of carboplatin which is associated with reduced relapse risk. Other contributors offer one cycle of carboplatin since OS is similar and data are limited for the long-term toxicities of carboplatin^¶.