Chemo vs. Radiation for Testicular Cancer

New research shows that a single dose of chemotherapy may be as effective as and less draining than radiation for testicular cancer.

The results, published in The Lancet, only cover the first four years after treatment. Longer-term results are not yet known, say the researchers.

They included Tim Oliver, MD, a medical oncology professor at Barts and the London Queen Mary's School of Medicine and Dentistry.

Understanding Testicular Cancer: Detection & Treatment

About Testicular Cancer

Testicular cancer is one of the most curable forms of cancer, with cure rates of more than 90% in all stages combined, states the web site of the American Cancer Society (ACS). When testicular cancer is caught early, as it often is, cure rates are near 100 percent.

The ACS predicts nearly 8,000 new cases of testicular cancer in the U.S. this year. Close to 400 men are expected to die from the disease.

Common symptoms of testicular cancer include:

—Lump on a testicle (often painless but may be uncomfortable)

—Swelling in the area of the testicle

—Heaviness or aching in the belly or scrotum

Less common symptoms include breast growth or tender/swollen breasts, loss of sex drive, and growth of hair on the face and body at a young age (before puberty), says the ACS.

Other conditions — such as an injured or infected testicle — may have symptoms that look like testicular cancer, the ACS says. Check with your doctor for a diagnosis.

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Chemo vs. Radiation

Oliver's study included 1,477 patients from 70 hospitals in 14 countries. All had early testicular stage I cancer called seminoma — one of the two most common types of testicular cancer. The men were 38 years old.

All of the men first got surgery to remove the affected testicle. Then, 885 men got radiation. The rest got one intravenous dose of the chemo drug carboplatin.

Surgery followed by radiation has been the standard treatment for the condition for nearly 50 years. The strategy is highly effective, with overall cure rates approaching 100%, write the researchers.

But, long-term effects of radiation have been seen in some men years down the road, including other cancers and heart disease.

The researchers wanted to determine if one dose of chemotherapy would yield the same positive results of radiation. Radiation usually involves several treatments per week over several weeks.

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Short-Term Results Look Good

Checkups were done every few months. The researchers plan to monitor the men for a decade.

So far, they found these results:

—Survival without recurrence of testicular cancer was similar in both groups over four years.

—Chemotherapy showed fewer toxic effects than radiation.

—Men taking chemotherapy returned to work faster than those getting radiation.

Few men from either group developed new testicular tumors. Early results showed fewer cases in the chemotherapy group. Those findings need more follow-up, the researchers write.

Another unanswered question is whether men treated with the single shot chemotherapy are more likely to have a cancer recurrence many years down the road.

Oliver's team notes anecdotal reports that early stage seminoma patients receiving carboplatin have good recovery of testicular function. That could bode well for sperm count and the ability to maintain fertility.

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Difference of Opinion

Not so fast, write Padraig Warde, MD, and colleagues.

They work in the radiation oncology department at the University of Toronto's Princess Margaret Hospital. Their comments appear in The Lancet.

"Whilst the results from this study confirm the benefit of carboplatin in stage I seminoma, we are not so sure that chemotherapy [after surgery] represents the best management strategy in this situation," they write.

The study's average follow-up was short and "further relapses might occur in patients treated with carboplatin," they write.

"Almost all patients with stage I seminoma are cured regardless of the choice of post-[surgery] management. The challenge for physicians involved in the care of these patients is to maintain this excellent cure rate, while minimizing treatment-related complications," they write.

By Miranda Hitti, reviewed by Michael W. Smith, MD

SOURCES: Oliver, R. The Lancet, July 23, 2005; vol 366: pp 293-300. American Cancer Society: "How Many Men Get Testicular Cancer?" American Cancer Society: "How Is Testicular Cancer Found?" Warde, P. The Lancet, July 23, 2005; vol 366: pp 267268. News release, The Lancet.