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Utility of serum tumor markers during surveillance for stage I seminoma - Abstract

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  • Utility of serum tumor markers during surveillance for stage I seminoma - Abstract

    Utility of serum tumor markers during surveillance for stage I seminoma - Abstract

    BACKGROUND: The serum tumor markers α-fetoprotein (AFP), β-human chorionic gonadotropin (HCG), and lactate dehydrogenase (LDH) are often measured as part of surveillance protocols in patients with stage I seminoma.

    In this study, the authors evaluated the utility of routine measurement of these markers in the detection of disease relapse.

    METHODS: Data were gathered from a prospectively maintained database of patients who underwent surveillance for stage I testicular seminoma diagnosed between 1982 and 2005 at Princess Margaret Hospital. Patients were followed on a predefined schedule with physical examination (PE), serum tumor markers, abdominopelvic computed tomography, and chest x-rays. The records of patients who relapsed were examined for details of imaging and serum tumor markers throughout the period of follow-up until the time of relapse.

    RESULTS:Of the 527 patients who were managed by surveillance, 75 patients (14%) relapsed at a median follow-up of 72 months. Of these, 65 patients relapsed within the first 3 years and had routine serum tumor markers measured. In total, 11 patients had abnormal tumor markers at the time of relapse (AFP, 0 patients; HCG, 6 patients; LDH, 4 patients; and HCG and LDH, 1 patient). Only 1 patient had an elevated tumor marker (LDH) before relapse, as defined by an abnormal imaging study (n = 64) or physical examination (n = 1), for which the treatment and outcome were not affected.

    CONCLUSIONS: Serum tumor marker levels did not aid in the early diagnosis of disease relapse in patients with stage I seminoma who were managed with surveillance. The current results indicated that routine measurement of serum tumor markers can be discontinued safely in seminoma surveillance schedules.

    Written by:
    Vesprini D, Chung P, Tolan S, Gospodarowicz M, Jewett M, O'Malley M, Sweet J, Moore M, Panzarella T, Sturgeon J, Sugar L, Anson-Cartwright L, Warde P.
    Department of Radiation Oncology, Sunnybrook Odette Cancer Center, Toronto, Ontario, Canada; Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.

    Reference: Cancer. 2012 Apr 19. Epub ahead of print.
    doi: 10.1002/cncr.27539

    PubMed Abstract
    PMID: 22517478
    "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)

  • #2
    Wow. That is interesting. I can't imagine that they will do away with measuring markers though on the basis of this study.
    Heidi

    Husband - age 51
    10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; -HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
    11/1/10 4X BEP
    12/7/10 End Cycle 2 - -HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
    2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
    6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
    Surveillance since 6/11

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    • #3
      Interesting indeed. It will take a few more confirming studies before markers stop being used routinely, I suspect. It might be interesting to comb the posts on this forum to see how many relapses were discovered by markers...

      This however was the best part of the research, IMHO:
      QUOTE=Paul54;172083]RESULTS:Of the 527 patients who were managed by surveillance, 75 patients (14%) relapsed at a median follow-up of 72 months. [/QUOTE]
      That means 86% were already cured & did not need further treatment. To me that is something to celebrate.

      Dave
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP

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      • #4
        I had started a thread a while back questioning the value of tumor markers for seminoma:
        http://www.tc-cancer.com/forum/showthread.php?t=17352

        I suspect that if you originally had tumor markers pre-IO, then a recurrence would be more likely to be detectable via markers.

        Does anybody have access to the full article?

        John
        Last edited by JPM; 09-29-12, 12:23 PM. Reason: Fixed Link
        JPM

        March 2011: Right I/O, Stage IA classic seminoma, 5.0 x 4.5 x 3.5 cm
        May 2011: Single-Agent Carboplatin
        Currently ALL CLEAR

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