Testicular Cancer- Chemotherapy Before Radiotherapy
Chemotherapy Before Radiotherapy for
Testicular Cancer Could Reduce Long-Term Side-Effects
Aug. 16, 2013 — Giving men with testicular cancer a single dose of chemotherapy
alongside radiotherapy could improve the effectiveness of treatment and reduce
the risk of long-term side-effects, a new study reports. As many as 96% of men with testicular cancer
now survive at least ten years from diagnosis (1), but more advanced
forms need to be treated with combination chemotherapy -- which can have
serious long-term complications. Researchers at The Institute of Cancer
Research, London, and The Royal Marsden NHS Foundation Trust have therefore
been searching for new treatments that would reduce the risk of relapse after
initial treatment and so spare as many men as possible from needing combination
chemotherapy.
The new pilot study, published in the August issue of the
Annals of Oncology, tested a new treatment in a pilot study of men with stage IIA and IIB testicular
seminoma -- where the cancer has spread to the lymph nodes in the
abdomen.
The researchers showed that giving chemotherapy drug carboplatin before
radiotherapy could reduce
relapse rates compared with radiotherapy alone -- cutting the numbers of
men who would need follow-up treatment. It also allowed radiation doses to be
reduced. The study was funded by The Institute of Cancer Research (ICR), the Bob
Champion Cancer Trust and Cancer Research UK, as well as through the NIHR
Biomedical Research Centre at The Royal Marsden and the ICR.
Researchers gave 51 men with stage IIA and IIB testicular
seminoma a single cycle of carboplatin
-- a low toxicity form of chemotherapy -- followed three to four weeks later by
radiotherapy. Most of the men were aged below 50, over a range of 18-73 years.
Adding carboplatin to 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) of radiation
to 30 Gy, delivered to a smaller area of the abdomen.
After an average of 4.5 years of follow-up, there were no
relapses of the cancer compared with a relapse risk of 5-11% after radiotherapy
alone. The side-effects from treatment were mild and only lasted a short time.Dr
Robert Huddart, Team Leader in the Division of Radiation and Imaging at the
Institute of Cancer Research, London, and Consultant at The Royal Marsden, who
led the study, said:
"The results of this study show great promise. Men who
have this stage of testicular seminoma are normally treated with just
radiotherapy, or in some countries with intensive combination chemotherapy,
where several anticancer drugs are given at once. Relapse occurs in 5-11% of
men after radiotherapy alone, and these recurrences have to be treated with
combination chemotherapy, which is associated with a risk of serious long-term
complications such as cardiovascular disease or second cancers.
"The aim of the study was to develop an effective
non-toxic treatment with low risk of long-term treatment complications, and our
findings suggest that a single cycle of carboplatin before radiotherapy may
reduce the chances of cancer reappearing compared with radiotherapy alone. This
will reduce the risk that these patients would need combination chemotherapy.
Not only that, but by adding carboplatin to the therapy, the radiation dose and volume
can be lowered."
As this was a small, single-centre study, the researchers
are recommending the approach is evaluated more widely.
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