Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System

Jonathan T. Wingate, Ruth Etzioni, Dusten M. Macdonald, Timothy C. Brand

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

For stage I testicular seminoma, the use of radiotherapy has declined, and surveillance is preferred. However, treatment trends in an equal-access US setting are not known. We examined the Department of Defense database and report the trends in 436 men. In our cohort, the decline in radiotherapy was replaced by chemotherapy, with no significant increase in surveillance. Background The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. Materials and Methods A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. Results The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P < .001 for 2006-2011 vs. 2001-2005; relative rate ratio, 19.3; 95% confidence interval [CI], 8.04-46.13). A later year of diagnosis was not significantly associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively. Conclusion The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population.

Original languageEnglish (US)
Pages (from-to)438-443
Number of pages6
JournalClinical Genitourinary Cancer
Volume14
Issue number5
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Seminoma
Radiotherapy
Registries
Drug Therapy
Adjuvant Radiotherapy
Delayed Diagnosis
Logistic Models
Confidence Intervals
Population
Recurrence
Neoplasms
Kaplan-Meier Estimate
Therapeutics
Survival Rate
Odds Ratio
Databases
Survival

Keywords

  • Adjuvant therapy
  • Chemotherapy
  • Radiotherapy
  • Surveillance
  • Testicular cancer

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System. / Wingate, Jonathan T.; Etzioni, Ruth; Macdonald, Dusten M.; Brand, Timothy C.

In: Clinical Genitourinary Cancer, Vol. 14, No. 5, 01.10.2016, p. 438-443.

Research output: Contribution to journalArticle

Wingate, Jonathan T. ; Etzioni, Ruth ; Macdonald, Dusten M. ; Brand, Timothy C. / Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System. In: Clinical Genitourinary Cancer. 2016 ; Vol. 14, No. 5. pp. 438-443.
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title = "Treatment Trends for Stage I Testicular Seminoma in an Equal-Access Medical System",
abstract = "For stage I testicular seminoma, the use of radiotherapy has declined, and surveillance is preferred. However, treatment trends in an equal-access US setting are not known. We examined the Department of Defense database and report the trends in 436 men. In our cohort, the decline in radiotherapy was replaced by chemotherapy, with no significant increase in surveillance. Background The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. Materials and Methods A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. Results The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9{\%} of patients received radiotherapy compared with only 24.0{\%} in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0{\%} to 38.0{\%}. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P < .001 for 2006-2011 vs. 2001-2005; relative rate ratio, 19.3; 95{\%} confidence interval [CI], 8.04-46.13). A later year of diagnosis was not significantly associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95{\%} CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0{\%} and 77.0{\%}, respectively. Conclusion The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population.",
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N2 - For stage I testicular seminoma, the use of radiotherapy has declined, and surveillance is preferred. However, treatment trends in an equal-access US setting are not known. We examined the Department of Defense database and report the trends in 436 men. In our cohort, the decline in radiotherapy was replaced by chemotherapy, with no significant increase in surveillance. Background The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. Materials and Methods A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. Results The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P < .001 for 2006-2011 vs. 2001-2005; relative rate ratio, 19.3; 95% confidence interval [CI], 8.04-46.13). A later year of diagnosis was not significantly associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively. Conclusion The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population.

AB - For stage I testicular seminoma, the use of radiotherapy has declined, and surveillance is preferred. However, treatment trends in an equal-access US setting are not known. We examined the Department of Defense database and report the trends in 436 men. In our cohort, the decline in radiotherapy was replaced by chemotherapy, with no significant increase in surveillance. Background The practice patterns for adjuvant therapies for stage I seminoma are rapidly evolving, and surveillance is currently preferred. How these recommendations have affected contemporary practice in an equal-access US population is unknown. Materials and Methods A total of 436 men diagnosed with clinical stage IA-IB seminoma from 2001 to 2011 were identified in the Automated Central Tumor Registry (ACTUR). The ACTUR is the cancer registry system for the Department of Defense. Logistic regression models analyzed the association between patient characteristics and adjuvant therapy. Overall and recurrence-free survival were determined from Kaplan-Meier analysis. Results The use of adjuvant radiotherapy in this population decreased significantly from 2001 to 2011. In 2001, 83.9% of patients received radiotherapy compared with only 24.0% in 2011. During that period, a concomitant increase occurred in the use of chemotherapy from 0% to 38.0%. A later year of diagnosis was significantly associated with a greater rate of receiving chemotherapy relative to radiotherapy (P < .001 for 2006-2011 vs. 2001-2005; relative rate ratio, 19.3; 95% confidence interval [CI], 8.04-46.13). A later year of diagnosis was not significantly associated with the receipt of surveillance (P = .412 for 2006-2011 vs. 2001-2005; odds ratio, 0.83; 95% CI, 0.54-1.29). Black race or age was not significantly associated with adjuvant therapy. With a median follow-up period of 4.7 years, the 5-year overall and recurrence-free survival rates were 98.0% and 77.0%, respectively. Conclusion The use of adjuvant radiotherapy has been replaced by chemotherapy for clinical stage I testicular seminoma in an equal-access system. The lack of an increase in active surveillance in our cohort might represent overtreatment of the population.

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KW - Testicular cancer

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