NEW YORK (Reuters Health) - The risk of death from heart disease or second cancer rises significantly above that of the general population 15 years after treatment for testicular seminoma with orchiectomy and radiation therapy, report physicians at the University of Texas M.D. Anderson Cancer Center in Houston.

The cure rate for testicular seminoma is higher than 95%, but because men are affected while still relatively young, longevity may be adversely affected by treatment, lead author Dr. Gunar K. Zagars and associates explain in the Journal of Clinical Oncology for February 15th. Understanding these risks should lead to better management strategies.

The investigators evaluated long-term survival for 453 patients treated between 1951 to 1999 for stage I or II seminoma who remained free of recurrence. During follow-up, 102 patients died. After 15 years, the observed survival was significantly lower than the general US population, after adjusting for age and race.

Beyond 15 years, overall mortality was 1.85-fold higher than expected, while death due to cardiac disease or cancer was 1.95 and 2.02 times higher than expected, respectively.

Dr. Zagars' team notes that without postorchiectomy treatment, 20% of patients with stage I and all of those with stage II disease "would have died quite quickly, dwarfing the excess mortality reported herein."

They suggest that, for stage I tumors treated with orchiectomy, lower radiation dose, substitution of carboplatin chemotherapy or surveillance may be safe alternatives to reduce long-term mortality risk. They still recommend radiation for treatment of stage II seminoma.

In a Journal editorial, Dr. Alan Horwich, an oncologist at the Institute of Cancer Research in Surrey, UK, notes that in his country, standard postorchiectomy treatment for patients with stage I seminoma is adjuvant radiotherapy to para-aortic nodes only to a dose of 20 Gy.

Although the risk with such treatment is probably low, "for those who find the risk unacceptable, there is preliminary evidence that surveillance may be a reasonable alternative," Dr. Horwich adds.

J Clin Oncol 2004;22:585-588,640-647

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