NEW ORLEANS, LA USA (UroToday.com) - In today’s socioeconomic podium session on practice patterns and cost effectiveness, Nikhil Waingankar from Fox Chase Cancer Center discussed the decline in the use of radiation for stage I seminoma. He introduced the topic by reporting that over 80% of patients with testicular seminoma present with stage I disease, and that 85% of these will be cured by orchiectomy alone. Post-orchiectomy management of stage I seminoma includes radiation, systemic platinum-based chemotherapy, and surveillance. Emerging data on comparative effectiveness, treatment morbidity, relapse rates, and effectiveness of cisplatin-based salvage chemotherapy have shifted the clinical landscape for management of stage I seminoma.
In his group’s study, the authors searched the NCDB for all patients with stage I seminoma diagnosed between 1998 and 2011. Rates of chemotherapy, radiation, and observation use were identified for each year. They defined observation as “no further treatment beyond orchiectomy.” Multivariate analysis was performed to identify any associations between receipt of radiation and: age, year of diagnosis, race, insurance status, income, education level, city size, geographic location, and T stage.
They found that 34 251 patients were diagnosed with stage I seminoma between 1998 and 2011. Of these, 20 627 patients overall were treated with radiation (60.2%), 11 346 patients overall were managed with observation (33.1%), and 2 278 patients overall were treated with chemotherapy (6.7%). Looking at trends of treatment over time, radiation use declined from 73.5% in 1998 to 29.6% in 2011 (p < 0.0001), while observation increased from 24.6% to 53.9% (p < 0.0001) and chemotherapy use increased from 1.9% to 16.5% (p < 0.0001).
On multivariate analysis, age 30-39 (OR 1.06, CI 1.01-1.13) and 40-49 (OR 1.10, CI 1.03-1.17) were associated with increased receipt of radiation. Uninsured patients (OR 0.78, CI 0.71-0.86) and those with Medicaid (OR 0.82, CI 0.73-0.92) and Medicare (OR 0.62, CI 0.55-0.69) were less likely to receive radiation compared with patients with private insurance. Patients with pT2 (OR 1.25, CI 1.17-1.32) and pT3 (OR 1.21, CI 1.04-1.41) tumors were more likely to receive radiation than those with T1. There were no associations between receipt of radiation and education level, median income, or city size. Finally, patients treated in East North Central (IL, IN, MI, OH, WI; OR 1.59 [CI 1.32-1.92]) and West North Central states (IA, KS, MN, MO, ND, SD, NE; OR 1.82 [CI 1.44-2.28]) were associated with increased utilization of radiotherapy.
Finally, the authors concluded that radiation use for treatment of stage I testicular seminoma is on the decline, while utilization of surveillance and chemotherapy has risen. Currently, observation is the most commonly utilized form of management for stage I testicular seminoma. Stage pT2 and pT3 disease, patient ages 30-49, North-Nentral US states, and non-Medicare/Medicaid public insurance status are associated with increased radiation use.
Presented by Nikhil Waingankar at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Fox Chase Cancer Center, Philadelphia, PA USA
Reported by Nikhil Waingankar, medical writer for UroToday.com