Clinical outcomes of stage IIA/IIB seminoma treated with radiotherapy and chemotherapy: Should regional therapy be considered the preferred treatment approach?
Bibliographic record
Abstract
629 Background: With the publication of the Surgery in Early Metastatic Seminoma Trial there has been increasing interest in the use of regional therapy as first line treatment (reserving systemic therapy for relapse) in patients with testicular seminoma with low volume with retroperitoneal lymphadenopathy. Herein, we sought to evaluate outcomes with both management approaches. Methods: A prospectively maintained single-institutional database was retrospectively queried for patients diagnosed between 1995-2016 with de novo clinical stage IIA/B (CSIIA/B) or who relapsed on surveillance (Rel-CSIIA/B) treated with radiotherapy or chemotherapy. All patients were reviewed by the multidisciplinary team; while the preferred management policy during this period was radiotherapy, all treatment decisions were individualized at the physician/patient level. Results: The median follow-up was 7.1 years (IQR 4.3-9.9). 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). One hundred and twenty patients (78%) received radiotherapy (IIA-78, IIB-42) and 33 (22%) received platinum-based chemotherapy (IIA-5, IIB-28). Eleven patients (IIA- 9/78, IIB- 2/42) relapsed following radiotherapy and 1 patient (IIB) relapsed following chemotherapy, corresponding to 5-year relapse rates of 10% for radiotherapy and 3% for chemotherapy. All 12 patients who relapsed were treated successfully with salvage chemotherapy. Conclusions: Regional therapy in patients with testicular seminoma with low volume with retroperitoneal lymphadenopathy gives excellent treatment results – recognising that a small proportion of patients will need salvage chemotherapy for cure, thereby exposing these patients to the morbidity of two treatment strategies. Our results support the view that regional therapy is a reasonable treatment option in this setting and should be discussed with all 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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".