Stage i testicular seminoma: A SEER analysis of contemporary adjuvant radiotherapy trends

Alan E. Thong, Daphne Y. Lichtensztajn, Leanne Almario, Alexandre Ingels, Scarlett Lin Gomez, Mark L Gonzalgo

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80% of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100%. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. Materials and Methods A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. Results The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7% of patients received radiation, compared with only 37.7% of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95% CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95% CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95% CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. Conclusions The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.

Original languageEnglish (US)
Pages (from-to)1240-1244
Number of pages5
JournalJournal of Urology
Volume190
Issue number4
DOIs
StatePublished - Oct 2013
Externally publishedYes

Fingerprint

Seminoma
Adjuvant Radiotherapy
Epidemiology
Social Class
Recurrence
Delayed Diagnosis
Registries
Guidelines
Radiation

Keywords

  • chemotherapy adjuvant
  • radiotherapy
  • SEER program
  • seminoma

ASJC Scopus subject areas

  • Urology

Cite this

Stage i testicular seminoma : A SEER analysis of contemporary adjuvant radiotherapy trends. / Thong, Alan E.; Lichtensztajn, Daphne Y.; Almario, Leanne; Ingels, Alexandre; Gomez, Scarlett Lin; Gonzalgo, Mark L.

In: Journal of Urology, Vol. 190, No. 4, 10.2013, p. 1240-1244.

Research output: Contribution to journalArticle

Thong, Alan E. ; Lichtensztajn, Daphne Y. ; Almario, Leanne ; Ingels, Alexandre ; Gomez, Scarlett Lin ; Gonzalgo, Mark L. / Stage i testicular seminoma : A SEER analysis of contemporary adjuvant radiotherapy trends. In: Journal of Urology. 2013 ; Vol. 190, No. 4. pp. 1240-1244.
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title = "Stage i testicular seminoma: A SEER analysis of contemporary adjuvant radiotherapy trends",
abstract = "Purpose Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80{\%} of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100{\%}. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. Materials and Methods A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. Results The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7{\%} of patients received radiation, compared with only 37.7{\%} of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95{\%} CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95{\%} CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95{\%} CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. Conclusions The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.",
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AU - Ingels, Alexandre

AU - Gomez, Scarlett Lin

AU - Gonzalgo, Mark L

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N2 - Purpose Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80% of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100%. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. Materials and Methods A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. Results The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7% of patients received radiation, compared with only 37.7% of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95% CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95% CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95% CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. Conclusions The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.

AB - Purpose Patients with clinical stage I testicular seminoma have historically been treated with adjuvant radiotherapy in the United States. However, nearly 80% of patients on surveillance will not experience relapse and even with relapse, salvage rates approach 100%. It remains unclear how practice patterns have changed with recently accumulating evidence and changes in guidelines. In a population based setting we evaluated contemporary trends and factors that may affect the use of adjuvant radiotherapy. Materials and Methods A total of 8,151 men diagnosed with stage I testicular seminoma from 2000 to 2009 were identified in the national SEER (Surveillance, Epidemiology, and End Results) registry. A multivariate regression model was constructed to analyze the association of year, age, race, socioeconomic status, SEER region, pathological stage and tumor size with the administration of adjuvant radiotherapy. Results The use of adjuvant radiotherapy decreased significantly from 2000 to 2009. In 2000, 74.7% of patients received radiation, compared with only 37.7% of patients in 2009 (p <0.0001). Later year of diagnosis was significantly associated with decreased odds of receiving adjuvant radiotherapy (p <0.0001, 2000 to 2005 vs 2006 to 2009, OR 0.40, 95% CI 0.36-0.44). Men age 35 years or older (p <0.0002, OR 1.20, 95% CI 1.09-1.32) and men in the highest socioeconomic index quartile (p <0.0001, OR 1.34, 95% CI 1.16-1.54) were more likely to receive adjuvant radiotherapy. Conclusions The use of adjuvant radiotherapy for clinical stage I testicular seminoma has decreased significantly in the last decade. Older age and higher socioeconomic status are associated with higher rates of adjuvant radiotherapy.

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