Radiation therapy may be superior to chemotherapy for patients with stage 2a-b testicular cancer, according to results presented at European Society for Therapeutic Radiology and Oncology (ESTRO) 35 (April 29-May 3, 2016; Turin, Italy).
These results come at a significant time, as many physicians are moving away from radiation treatment in favor of chemotherapy for this patient population.
Scott Glaser, MD, University of Pittsburgh Cancer Institute (PA), explained that he and his colleagues conducted a study to evaluate chemotherapy and radiation therapy in the largest group of patients with stage 2 testicular seminoma ever recorded (n = 2437). The primary outcome measure was overall survival at 5 years.
All patients were diagnosed between 1998 and 2012 and treated with radiation therapy or multi-agent chemotherapy after the removal of the cancerous testicle. Of those patients, 960 had stage 2a disease (78% and 22% receiving radiation therapy, and chemotherapy, respectively), 812 had stage 2b disease (54% and 46% receiving radiation therapy, and chemotherapy, respectively),
Significantly higher 5-year survival rates were found in patients with stage 2a and stage 2b disease treated with radiation ( 99% and 95%, respectively) than in patients treated with chemotherapy (93% and 92%, respectively).
Of the 665 patients with stage 2c disease, 4% received radiation therapy, and 96% received chemotherapy. Dr Glaser explained that chemotherapy is the preferred regimen for these patients because the risk of distant progression is high. Thus, meaningful comparison between treatments was not possible for these patients.
Conversely, there is no such consensus in patients with stage 2a-b disease, which is why practice patterns varied more significantly. Still, the results of the presented study supported current recommendations that radiation therapy be the preferred treatment option for patients with 2a-b testicular cancer.
Limitations of the study included its retrospective nature, a relatively short follow-up period of 65 months (because toxic effects of treatment can become apparent after longer follow-up), and the lack of data regarding how well the disease was controlled through treatment and what deaths were due specifically from cancer. Dr Glaser concluded by calling for more research on the subject.
