Article
Follow-up strategies after paraaortic (PA) radiotherapy for stage I seminoma: What should we do and when should we do it?
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Authors
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Johannes Claßen
- Universitätsklinikum, Tübingen, Deutschland
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Rainer Souchon
- Allgemeines Krankenhaus, Hagen
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Stefan Lächelt
- Universitätsklinikum, Tübingen
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Jörg T Hartmann
- Universitätsklinikum, Tübingen
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Thomas Hehr
- Universitätsklinikum, Tübingen
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Michael Bamberg
- Universitätsklinikum, Tübingen
| Published: | March 20, 2006 |
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Outline
Text
Backgrond: Radiotherapy is an accepted and highly efficient strategy for adjuvant treatment of stage I seminoma. Routine post-treatment surveillance is recommended for early detection of relapse in order not to compromise survival. However, there is a lack of evidence with regard to the efficacy of follow-up strategies, to the frequency of follow-up appointments, and to the optimal use of technical investigations of post-treatment surveillance.
Methods: We analysed all reported trials on PA radiotherapy with respect to the pattern of relapse, to reported indications of relapse, and to the use of technical investigation of follow-up.
Results: Excluding multiple reports of individual trials we identified 12 series on PA radiotherapy with 2310 treated patients (PTS). Median time to relapse in 80 recurring PTS was 15 months (range, 1-89 months). Locoregional (LR), distant only (DO) and locoregional&distant (LRD) failure was observed in 53, 19, and 8 PTS, respectively. Median time to relapse in LR, DO, and LRD PTS was 14, 16, and 13 months (log-rank, p>0.05), respectively. Relapse beyond the third year after radiotherapy was observed only in LR PTS (n=7). Indications of relapse were available in 48 recurring PTS. Physical examination or clinical symptoms were indicative of relapse in 27.1%, and 25%, respectively. Chest or abdomino-pelvic imaging and marker analysis revealed relapse from seminoma in 10.4%, 25.0%, and 12.5%, respectively. Disease-specific survival (DSS) approached 100% in all reported series, and no influence of the mode of detection or the use of different follow-up strategies on DSS could hence be detected.
Conclusions: We conclude, that there is no use of technical investigations during post-treatment surveillance beyond the third year after radiotherapy. We suggest that the frequent use of thoracic screening and marker analysis during follow-up should be reconsidered while abdomino-pelvic screening is a valuable procedure associated with the highest probability of detecting recurrent disease among all technical investigations recommended for post-treatment surveillance. Thorough physical examination and education of the PTS on potential clinical symptoms of relapse are mandatory.
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