The management of Stage I testis cancer patients post orchidectomy has evolved in recent years. There has been a move away from adjuvant chemotherapy towards active surveillance protocols.
We performed a retrospective audit of (50) patients who underwent an orchidectomy for testicular cancer in the Orange area from Jan 2010 to Dec 2015. The study period spanned 2 distinct eras: Jan 2010 to Apr 2013, when patients were treated by non-resident medical oncologists, and April 2013 to Dec 2015, when patients were managed by medical oncologists residing in Orange. We sought to determine if the management of Stage I patients was significantly different across eras. Outcomes of interest were site of relapse, time to relapse, need for hospitalisation as a result of chemotherapy toxicity and the costs incurred from use of chemotherapy as well as antibiotics and granulocyte colony stimulating factor (GCSF) to treat chemo-induced infections and cytopenias.
There were 8 cases of relapse in the active surveillance group and 3 in the chemotherapy group, all except one happening within the first 2 years of diagnosis. The relapse cases in the active surveillance groups were successfully treated with chemotherapy with no further evidence of disease at the time of the audit. There was no significant differences in hospitalisation, use of IV medications or use of colony-stimulating factors between the two groups.
Results of this audit indicate that despite the higher rate of relapse in the active surveillance group, the short-term outcomes are similar between active surveillance and chemotherapy, with the potential benefit of avoiding long-term chemotherapy side effects and costs with an active surveillance strategy.