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

[ukboyuk]

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

http://www.jcojournal.org/content/29/8/949.full

[Aegean]

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.

[ukboyuk]

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.

[strongwife]

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.

[S P]

Bump for the couple of active threads on this. A very good paper. Just read it in full myself.

[K&R]

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.

[detaildevil]

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.

[Paul54]

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.