Poster, Podium & Video Sessions
Presentation Authors: Michael Leveridge*, D Robert Siemens, Kelly Brennan, Jason Izard, Safiya Karim, Christopher Booth, Kingston, Canada
Introduction: Treatment guidelines for early-stage testicular cancer have increasingly recommended de-escalation of therapy. We sought to describe changes in routine clinical practice and whether this has compromised survival in the general population.
Methods: The Ontario Cancer Registry was linked to electronic records of treatment to identify all patients diagnosed with testicular cancer and treated with orchiectomy in Ontario during 2000-2010. Treatment after orchiectomy was classified as radiotherapy (RT), retroperitoneal lymph node dissection (RPLND), chemotherapy, or none. Stage of disease at diagnosis was not available. Cancer-specific (CSS) and overall survival (OS) were measured from date of orchiectomy. The chi-squared test was used to evaluate temporal trends in practice patterns; the log-rank trend test was used to evaluate whether outcomes changed over time.
Results: Orchiectomy pathology reports were available for 86% (2821/3281) of all cases in Ontario; the study population included 1580 and 1105 cases of seminoma and non-seminoma (NSGCT); other histologies were excluded. Median age was 34 years. Among patients with seminoma there was a significant increase in the proportion of patients with no active treatment after orchiectomy (from 33% to 66%, p<0.001). Use of RT decreased over time (57% to 18%, p<0.001) and use of chemotherapy remained stable (from 16% to 17%, p=0.344). Post-orchiectomy practice patterns remained relatively stable among patients with NSGCT: no treatment 29% to 41% (p=0.221); chemotherapy 69% to 55% (p=0.203); RPLND 27% to 26% (p=0.308). Among the 296 patients undergoing RPLND, 61% were performed in the post-chemotherapy setting; this proportion remained stable over time (p=0.423). OS for the entire cohort at 5 and 10 years was 96% and 94%. CSS at 5 and 10 years was 97% and 97%. There was no significant change in OS or CSS for seminoma (98% and 99% respectively) or NSGCT (96% and 96%) over the study period.
Conclusions: Since 2000 there has been de-escalation of treatment among men with seminoma, with surveillance alone predominating in recent years. Practice patterns for NSGCT have remained stable since 2000. Outcomes achieved in the general population are very good and have not decreased over time with de-escalation of therapy.
Source Of Funding: none
Dr. Leveridge is currently an Assistant Professor in the Departments of Urology and Oncology at Queens University in Kingston Ontario. He completed his medical degree at the University of Toronto in 2003, followed by urology residency training at Queen's University. Dr. Leveridge's fellowship in urologic oncology was completed at Princess Margaret Hospital at the University of Toronto in 2010. His clinical focus is urologic oncology in addition to a general urology practice. Research interests include the use and value of social media in urology as well as population level research in bladder cancer and testicular cancer outcomes.
Friday, May 12
2:30 PM – 2:40 PM