Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma
Menée sur 51 patients atteints d'un séminome testiculaire de stade IIA ou IIB traité entre 1996 et 2011 (durée médiane de suivi : 55 mois), cette étude évalue l'intérêt d'une chimiothérapie par carboplatine avant une radiothérapie pour réduire le risque de récidive
Background Extended field radiotherapy is a standard of care for low volume stage II testicular seminoma. We hypothesized that neoadjuvant carboplatin might reduce the recurrence risk.Patients and methods In a single-arm study, 51 patients were treated between May 1996 and November 2011 with a single cycle of carboplatin followed by radiotherapy. The radiation field was reduced from an extended abdomino-pelvic field to just the para-aortic region, and the radiation dose from 35 Gy to 30 Gy in 39 patients.Results After a median follow-up of 55 months (range 8–151 months) with 38 (74%) of the patients having been followed for >2 years, there have been no relapses (95% confidence limits of 5-year relapse-free survival of 93%–100%). Toxicity has been low with grade 3 toxicity limited to four patients with grade 3 haematological toxicity (with no clinical sequelae) and one patient with grade 3 nausea (during radiotherapy). No patients experienced grade 4 toxicity.Conclusions The results of this pilot study suggest that a single cycle of neoadjuvant carboplatin before radiotherapy may reduce recurrence risk compared with radiotherapy alone and permit a smaller radiation field, and this approach is proposed for further investigation.