Currently, most men with early-stage disease undergo surgery to remove the affected testicle, then have follow-up radiation therapy to make sure the cancer is "cured." Using a combination of surgery, radation, and chemotherapy, this cancer has one of the highest cure rates of all cancers.
But radiation therapy, which requires several weeks of treatment, can cause cancer to occur in other organs two decades or more after the original cancer is treated, says R. Timothy Oliver, MD, professor of oncology at Barts and the London Queen Mary's School of Medicine.
Moreover, radiation therapy can damage the remaining testicle, thus destroying fertility.
Testicular cancer accounts for only about 1% of all cancers in men -- usually young men, according to the National Cancer Institute.
Oliver presented his findings at the annual meeting of the American Society of Clinical Oncology.
A better option, he says, is a single shot of Paraplatin, a potent chemotherapy drug. Oliver tells WebMD this single-shot treatment is as effective as radiation for preventing recurrence of seminoma, which is a common type of testicular cancer.
Oliver tested this approach in 1,447 men who received either radiation treatment or the one-shot chemotherapy treatment. During the study from June 1996 to March 2001, 543 men had the one shot therapy while 904 men had radiation therapy.
"After three years, there was no significant difference in relapse-free survival," he says. The disease-free survival in the Paraplatin group was just over 95% and it was 97% in men treated with radiation.
And in terms of actual recurrences of cancer, new cancers were later detected in 10 men treated with radiation, while only two men in the chemotherapy group had recurrent cancers.
Oliver says the one-shot treatment is also less toxic then radiation. And most men reported less fatigue and nausea, which meant they were able to return to work sooner than men treated with radiation.
Robert J. Mayer, MD, director of gastrointestinal oncology at the Dana-Farber Cancer Institute, tells WebMD the study results are important because even though testicular cancer has a high cure rate with radiation therapy, "it's important that we select treatments that are the least toxic to our patients." He notes, however, that long-term data are needed to confirm Oliver's finding that one-shot treatment is as good or better than radiation.
If the positive results of this study stand the test of time -- if results at 10 or 20 years are as promising as these early results -- Oliver says it may be possible to treat testicular cancer by removing just the cancerous tissue, rather than the entire testicle. That would mean that "for the first time, men may have the option of testicular-conserving therapy just as women undergo lumpectomy to save their breasts."
SOURCES: American Society of Clinical Oncology 2004m Abstract 4517: "A randomised comparison of single agent carboplatin with radiotherapy in the adjuvant treatment of stage I seminoma of the testis, following orchidectomy." R. Timothy Oliver, MD. Robert Mayer MD.