Stage I Seminoma with Larger Primary Tumour Size or Rete Testis Infiltration: Treatment for Higher-Risk Patients
Stage I seminoma is not a uniform disease from a risk perspective. Patients presenting with one or both of the recognised risk factors — a larger primary testicular tumour or rete testis infiltration — fall into the higher-risk group and warrant a distinct management discussion beyond surveillance alone.
Clinical Scenario
Stage I seminoma — disease confined to the testis — in the presence of one or both of the following risk factors:
Larger primary testicular tumour size and/or rete testis infiltration
Risk is stratified by these two features: lower risk is defined as absence of both; higher risk as the presence of one or either.
Treatment Approach
For higher-risk stage I seminoma — particularly in patients who are not suitable for or do not opt for active surveillance — adjuvant chemotherapy is a guideline-supported intervention. The full protocol defines the specific agent, the number of cycles, and the precise dosing parameters.
References
DOI: 10.1016/j.annonc.2022.01.002
- In seminoma clinical stage I, tumour size and possibly rete testis infiltration represent weaker risk factors identifying 'higher-risk' patients.
- Lower and higher risk based on size of primary tumour and infiltration of rete testis with lower risk defined as absence of both risk factors and higher risk as presence of one or both risk factors.
- Adjuvant ChT with one course of carboplatin with an area under the curve (AUC) of 7 should be discussed with patients not willing or not able to undergo surveillance or higher-risk patients, defined by the presence of one or both risk factors, i.e. tumour size and rete testis invasion.
- Based on the modest benefit of the second course of carboplatin and the limited data available, one course of carboplatin AUC 7 is recommended.
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