Clinical Characteristics and Outcomes of Late Relapse in Stage I Testicular Seminoma

Abstract Aims To identify the characteristics and outcomes associated with late relapse in stage I seminoma. Materials and methods A retrospective review was carried out of all patients with stage I seminoma managed at our institution between 1981 and 2011. Data were obtained from a prospectively maintained database. Late relapse was defined as tumour recurrence > 2 years after orchiectomy. Results Overall, 1060 stage I seminoma patients were managed with active surveillance ( n =766) or adjuvant radiotherapy ( n =294). At a median follow-up of 10.6 years (range 1.2–30), 142 patients relapsed at a median (range) of 14 (3–129) months; 128 on active surveillance and 14 after adjuvant radiotherapy. The late relapse rate for the active surveillance and adjuvant radiotherapy groups was 4% and 1%, respectively. There was no specific clinicopathological factor associated with late relapse. Isolated para-aortic node(s) was the most common relapse site in active surveillance patients either in late (88%) or early relapse (82%). Among the active surveillance group, no patients with late relapse subsequently developed a second relapse after either salvage radiotherapy ( n =25) or chemotherapy ( n =6), whereas in early relapse patients a second relapse was reported in seven (10%) of 72 patients treated with salvage radiotherapy and one (4%) of 23 patients who received chemotherapy; all second relapses were subsequently salvaged with chemotherapy. No patient in the adjuvant radiotherapy group developed a second relapse after salvage chemotherapy ( n =10) or inguinal radiotherapy/surgery ( n =4). Of seven deaths, only one was related to seminoma. Among active surveillance patients, the 10 year overall survival for late and early relapse groups were 100% and 96% ( P  = 0.2), whereas the 10 year cancer-specific survival rates were 100% and 99% ( P  = 0.3), respectively. Conclusions In stage I seminoma, the extent and pattern of late relapse is similar to that for early relapse. For active surveillance patients, selective use of salvage radiotherapy/chemotherapy for relapse results in excellent outcomes regardless of the timing of relapse, whereas salvage radiotherapy for late relapse seems to be associated with a minimal risk of second relapse.