Clinical Outcomes of Stage IIA/IIB Seminoma Treated With Radiation Therapy and Chemotherapy: Should Regional Therapy be Considered the Preferred Treatment Approach?
Bibliographic record
Abstract
PURPOSE: The optimal management of patients with de novo clinical stage IIA/B (CSIIA/B) or relapsed CSIIA/B (Rel-CSIIA/B) seminoma remains debated because of a lack of randomized evidence. Here, we sought to evaluate outcomes after radiation therapy and chemotherapy in this setting. METHODS AND MATERIALS: A prospectively maintained single-institutional database was retrospectively queried for patients diagnosed between 1995 and 2016 with de novo or Rel-CSIIA/B. Patients with Rel-CSIIA/B were managed similarly to de novo CSIIA/B. All patients were reviewed by the multidisciplinary team. Although the preferred management policy was radiation therapy, the treatment decision was individualized at the physician/patient level. RESULTS: There were 153 patients: 67 had de novo CSIIA/B (IIA-32, IIB-35) and 86 patients had Rel-CSIIA/B seminoma (IIA-51, IIB-35). Of the total, 120 patients (78%) received radiation therapy (IIA-78, IIB-42) and 33 (22%) received platinum-based chemotherapy (IIA-5, IIB-28). Median follow-up was 7.1 years (interquartile range, 4.3-9.9 years). Eleven patients (IIA-9/78, IIB-2/42) relapsed after radiation therapy and 1 patient (IIB) relapsed after chemotherapy, corresponding to 5-year relapse rates of 10% (95% CI 6%-18%) for radiation therapy and 3% (95% CI, 0%-23%) for chemotherapy. All 12 patients who relapsed were treated with subsequent chemotherapy. CONCLUSION: Radiation therapy and chemotherapy result in excellent oncologic outcomes for patients with de novo or Rel-CSIIA/B seminoma. All patients should be informed about both management options. However, radiation therapy with its favorable acute toxicity profile could be considered the treatment of choice in most patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".