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Carboplatin in Clinical Stage I Seminoma: Too Much and Too Little at the Same Time

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  • Carboplatin in Clinical Stage I Seminoma: Too Much and Too Little at the Same Time

    Another full article, this time by authors at MSK. Again, very interesting reading:

    http://www.jcojournal.org/content/29/8/949.full
    100% classical seminoma (I-A, RTI). Surveillance (no adjuvant therapy). 4 years all-clear and hoping for many more.

  • #2
    to me the following stuck out:

    Lymphovascular invasion is not a predictive factor for relapse in CS I seminoma compared with its importance in CS I nonseminomatous GCTs.
    Everything else was pretty much in line with the base assumption that 80 to 85 percent of pt1's are getting treated needlessly with either RT or carbo.
    Best,

    Zsolt


    Friendship is born at that moment when one person says to another; "What! You too? I thought I was the only one." - C.S Lewis

    “Experience: that most brutal of teachers. But you learn, my God do you learn.” - C.S. Lewis


    Mass found 11/20/08
    Left I/O 11/25/08
    Pathology: Seminoma, Stage 1
    Surveillance: All Clear since

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    • #3
      Originally posted by Aegean View Post
      to me the following stuck out:



      Everything else was pretty much in line with the base assumption that 80 to 85 percent of pt1's are getting treated needlessly with either RT or carbo.
      I think our Paul may be happy to learn of that.


      I think it's worth remembering the converse of your statement too, that 12 to 17 per cent are needless being treated with RT/BEP/EP which all have significant long term side effects, vs a shot or two of carbo which doesn't appear (yet) to have any.
      100% classical seminoma (I-A, RTI). Surveillance (no adjuvant therapy). 4 years all-clear and hoping for many more.

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      • #4
        This was an interesting article to have read. While I did get lot in a lot of the medical jargon, it did lead me to second guess the choice of Don choosing carboplatin.
        Codi wife to Don
        Don diagnosed 10-6-11
        Right Orchiectomy 10-6-11
        Pure Seminoma with extensive vascular invasion
        Stage 1B
        Tumor is 3.0 x 2.4 x 2.4 cm
        Tumor Markers BHCG and AFP normal, LDH 172
        Chest X-Rays and Abdominal CT Scan 10-12-11 Clear
        Chest and Brain CT Scans 11-4 Clear
        Chemo, 1 dose of Carboplatin 11-9-11
        Post Chemo labs, 11-17-11, Look Good
        1-29-12, All Clear
        6-11-12 Labs look good, Scans three enlarged lymph nodes in the abdomen
        10-24-12 Surveillance on lymph nodes
        sigpic

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        • #5
          Bump for the couple of active threads on this. A very good paper. Just read it in full myself.
          Young Adult Cancer Survivorship by Steve Pake
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          • #6
            It was interesting reading, but count me as skeptical about their conclusions. They discount the effectiveness of Carbo for Stage 1 by citing a study that used it to treat Stage IIA/B. They lead you to believe that the toxicity of Carbo is the same as EP/BEP. They say that the Oliver study isn't sufficient to understand the risk of long-term cardiovascular disease or secondary cancers - this seems a bit unfair considering this wasn't part of the study. Carbo has been in use since 1989 and there is little evidence uncovered of either of these problems.

            I do fully agree with their conclusion that from the point of view of patient survival, less treatment is better - hence surveillance is the best choice. That being said, since the survival for all three options for Stage 1 have equal disease specific survival rates, we have the luxury to make a choice based on other factors - like availability of future health care, impact of BEP/EP or stronger radiation later, risk and impact of secondary cancers, stress management, etc....

            Note: their argument that Carbo doesn't save you from radiation from all the follow-up CTs is blunted by the new NCCN guidelines which set the total at 3 for both Carbo and RT.
            Last edited by K&R; 01-26-12, 03:58 PM. Reason: Incomplete
            2 Feb 2009 - GP, Urologist, ultrasound
            3 Feb - Right I/O, Stage 1B (pT2) - Seminoma - 4.5cm , LVI+, Rete Testis "appears negative"
            Pathology 2nd opinion (MSKCC): Rete Testis involvement confirmed
            Treatment 2xCarboplatin: 10 Mar (800mg)/31 Mar (860mg)
            Surveillance protocols: NCCN v2.2009 through Jan 2012 (11 CTs) NCCN v1.2013 - through May 2014 -- All Clear

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            • #7
              Still a fan...

              Just wanted to point out the letters to the editor regarding this article. I found them here:
              http://www.mygazines.com/issue/46637/206 (weird link, yes I know).

              One other thought. Age factored in my own decision for carboplatin. The willingness to risk relapse may be different when you are 50 than when you are 25. Being....ur....more mature, I preferred to accept the still unknown (and presumably later) risk of adjuvant treatment over the risk of certain unpleasantness of relapse treatment. Quibbling over unknowns probably isn't worth it. I'm happy with my choice and at 3.5+ years out, not looking over my shoulder.

              Best wishes.
              detaildevil

              Jun-08 Rt I/O, Seminoma , tumor ~2 cm, with rete testis involvement; markers normal, CXR & CT normal >> Stage I;
              July/Aug-08: 2 rounds of carboplatin; CTs through Jan-12 all clear.

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              • #8
                DD,
                Thanks for finding and posting this. As much as Dr. Einhorn is the master of TC overall, I would consider Tim Oliver to be the master of adjuvant treatment for seminoma. If he says that carboplatin is a safe and wise choice with significantly increased RFR and minimal long-term side effects, I say listen closely. On the other hand, I know from reading many posts from guys with seminoma, MSK is heavily biased toward radiation.
                "Statistics are human beings with the tears wiped off" - Paul Brodeur
                Diagnosis: 05Sept07 Right I/O: 13Sept07; Pure Seminoma; Surveillance only per NCCN: All Clear August2013 (CT scan, Markers)

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