Chemotherapy before radiotherapy could reduce long-term side effects in testicular cancer

Giving men with testicular cancer a single dose of chemotherapy alongside radiotherapy could improve the effectiveness of treatment and reduce the risk for long-term side effects, according to a new study.

Though as many as 96% of men with testicular cancer now survive at least 10 years from their diagnosis, more advanced forms of the disease need to be treated with combination chemotherapy. The combination chemotherapy can have serious long-term complications. These concerns have led researchers to search for new treatments that would reduce the risk for relapse after initial treatment and so spare as many men as possible from needing combination chemotherapy.

The new pilot study, published in the Annals of Oncology (2013; 24(8):2104-2107), tested a new treatment in 51 men with stage IIA and IIB testicular seminoma—where the cancer has spread to the lymph nodes in the abdomen. The researchers gave the enrolled patients a single cycle of carboplatin, which is a low toxicity form of chemotherapy, followed 3 to 4 weeks later by radiotherapy.

The researchers, who are from The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, both in London, United Kingdom, showed that giving carboplatin before radiotherapy could reduce relapse rates compared with radiotherapy alone, which could cut the number of men who need follow-up treatment.

Adding carboplatin to the patients' treatment plans allowed doctors to give a lower dose of radiation over a smaller area of the body for most of the men in the study. Some 39 of the men in the study had their prescription of radiation reduced from the standard 35 Grays (Gy) to 30 Gy, delivered to a smaller area of the abdomen.

After an average of 4.5 years of follow-up, no relapses of the cancer had occurred. This compared favorably with the relapse risk of 5% to 11% after radiotherapy alone. The side effects from the treatment were mild and only lasted a short time.

Robert Huddart, MD, PhD, stated that this study's results show great promise. Their findings suggest that a single cycle of carboplatin before radiotherapy may reduce the chances of cancer reappearing compared with radiotherapy alone, and the radiation dose and volume also can be lowered.
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