#SUO14 - Abstract and Poster: Decline in the use of radiation for stage I seminoma: Analysis of the National Cancer Database

BETHESDA, MD USA (UroToday.com) - Background: Historically, primary radiotherapy has been the preferred treatment modality for stage I seminoma. However, there is emerging consensus that observation or primary chemotherapy may be the preferred management strategies to reduce overtreatment and risk of secondary malignancy. Hypothesizing that the use of radiotherapy has decreased in the modern era, our objective was to assess temporal practice patterns in stage I seminoma using a large national cancer registry.

Methods: The National Cancer Database (NCDB) was queried for all patients diagnosed with stage I seminoma from 1998 to 2011. Temporal trends for receipt of systemic chemotherapy, radiation, and observation (defined as no treatment) were assessed. Following adjustment for patient, demographic, and clinicopathologic characteristics, generalized estimating equations were used to assess for associations between covariates and receipt of primary radiotherapy.

suo 2014 poster radiation decline seminomaResults: Of the 34,251 patients identified with stage I seminoma in the NCDB, 20,627 were treated with radiation (60.2%), 2,278 were treated with chemotherapy (6.7%), and 11,346 were managed with observation (33.1%). Radiation use significantly declined from 73.5% in 1998 to 29.6% in 2011 (p<0.0001), while utilization of chemotherapy (1.9% to 16.5%, p<0.0001) and observation (24.6% to 53.9%, p<0.0001) markedly increased. Following adjustment, age categories 30−39 years (OR 1.06 [CI 1.01−1.13]) and 40−49 years (OR 1.10 [CI 1.03−1.17]), pathologic stage T2 (OR 1.25 [CI 1.17−1.32]) and T3 (OR 1.21 [CI 1.04−1.41]), and facilities located in the East North Central (IL, IN, MI, OH, WI; OR 1.59 [CI 1.32-1.92]) and West North Central states (IA, KS, MN, MO, ND, SD, NE; OR 1.82 [CI 1.44-2.28]) were associated with increased utilization of radiotherapy. Uninsured patients (OR 0.78 [CI 0.71−0.86]) and those with Medicaid (OR 0.82 [CI 0.73−0.92]) or Medicare (OR 0.62 [CI 0.55−0.69]) were less likely to undergo primary radiotherapy, while those with other government insurance were more likely to receive radiation (OR 1.40 [CI 1.13-1.75]).

Conclusions: Utilization of radiation therapy for stage I seminoma is on the decline. Coinciding with shifts in evidence−based guidelines, observation is now the most commonly employed management strategy for patients with Stage I seminoma.

Presented by:
Nikhil Waingankar, Elizabeth Handorf, Marc Smaldone, Elizabeth Plimack, Yu−Ning Wong, Mohammed Haseebuddin, Eric Horwitz, Robert Uzzo, Alexander Kutikov
Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA USA

Presented at the 2014 Winter Meeting of the Society of Urologic Oncology (SUO) "Defining Excellence in Urologic Oncology" - December 3 - 5, 2014 - Bethesda, MD USA