One-day treatment with the anticancer drug carboplatin is as effective and less toxic than three weeks radiation therapy for a type of testicular cancer, according to a report published in this week’s issue of The Lancet.
For the last 50 years standard care for stage 1 seminoma - a cancer of the testes - has been surgical removal of the cancerous testicle (hemi-castration) followed by three weeks radiotherapy. However, patients treated in this way and followed up for up to 30 years have shown increased risk of cancer in another organ and heart disease that begins after 15 years.
Tim Oliver (St Bartholomew’s and The London School of Medicine, London, UK) and colleagues recruited 1477 patients with stage 1 seminoma from 70 hospitals in 14 countries to compare radiotherapy with chemotherapy treatment. Between 1996 and 2001, the researchers randomly assigned 543 patients with stage I seminoma to receive a single course of carboplatin and 904 patients to receive radiation therapy. After a median follow-up of 3 years, they found that relapse-free survival was similar between the two groups (95·4% for the carboplatin group vs 96·6% for radiation therapy). At 5 years they also found that patients receiving carboplatin were less likely to develop tumours in their remaining testicle.
Professor Oliver states: “This large randomised trial finally establishes after 20 years of research and uncertainty that it is safe to risk less treatment in these patients. We found that one dose of carboplatin in the short term is as safe as radiation and is less toxic. Patients assigned to chemotherapy also had fewer seminomas occurring in the remaining testis than those receiving radiotherapy. Though needing longer follow up and larger numbers to be sure, this surprising finding, were it to apply to primary tumours when first diagnosed is the first hint that it may now be safe to embark on studies of testis conservation instead of hemicastration.”