An EORTC/MRC study randomised 1477 stage 1 seminoma patients to either a single dose of carboplatin (AUC 7) or radiation therapy (para-aortic strip or dog-leg). 904 and 573 patients received radiation therapy and carboplatin, respectively.
With a median follow-up of 6.5 years, relapse-free survival rates for radiation therapy and carboplatin were similar (96% vs 94.7% at 5 years, respectively; hazard ratio 1.25; p=0.37).r Therefore confirming the non-inferiority of single dose carboplatin versus radiation therapy in terms of relapse free rate. A statistically significant reduction medium term risk of second germ cell tumours with carboplatin was also demonstrated(Carboplatin n=2; RT n=15; hazard ratio, 0.22; p=0.03). This update did not contain any new toxicity data.
In the original report patients given carboplatin were less lethargic and less likely to take time off work than those given radiation therapy. New, second primary testicular germ-cell tumours were reported in ten patients allocated irradiation (all after para-aortic strip field) and two allocated carboplatin. One seminoma-related death occurred after radiation therapy and none after carboplatin. Preliminary evidence indicated a reduced incidence of cancer in the contra-lateral testis.r
Efficacy
New, second primary testicular germ-cell tumours were reported in ten patients allocated irradiation (all after para-aortic strip field) and two allocated carboplatin. One seminoma-related death occurred after radiation therapy and none after carboplatin.r
Relapse-free rate allocated by treatment:r
© JCO 2011
Toxicity
There were significantly higher rates of grade 3-4 thrombocytopaenia in the patients receiving carboplatin 17 (4%) vs 0; p=<0.0001 and significantly more dyspepsia in those receiving radiation therapy 127 (17%) vs 40 (8%); p=<0.0001 . Patients given carboplatin were less lethargic and less likely to take time off work than those given radiation therapy. New, second primary testicular germ-cell tumours were reported in ten patients allocated irradiation (all after para-aortic strip field) and two allocated carboplatin. One seminoma-related death occurred after radiation therapy and none after carboplatin.r