A131
Use of imaging-based surveillance for post-operative management of stage I seminoma testis patients and the TRISST trial
Rhian Gabe1, Fay Cafferty1, Tahera Hussain1, Hassan Khan1, Sally Stenning1, Leanne Alder2, Colin Howard3, Robert Huddart4, Michael Williams5, Johnathan Joffe6
1Medical Research Council Clinical Trials Unit, London, UK, 2Nottingham Cancer Clinical Trials Team, Nottingham University Hospitals NHS Trust, Nottingham, UK, 3Consumer representative, York, UK, 4Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK, 5Derriford Hospital, Plymouth, Devon, UK, 6Huddersfield Royal Infirmary, Huddersfield, West Yorkshire, UK
Background
Post-orchidectomy surveillance is used widely for stage I non-seminoma patients. However, for seminoma patients, later relapses, the efficacy of adjuvant treatments and relative lack of tumour markers means this strategy has taken longer to become standard management. Nevertheless, since only 15-20% of patients relapse, and virtually all are subsequently cured, surveillance is logical. In 2006, The European Consensus meeting recommended surveillance for all low and intermediate risk patients.
We explore the UK uptake of this recommendation before and after the launch of a randomised trial designed to find the optimal imaging-based surveillance strategy for these patients. The trial includes evaluation of MRI as an alternative to CT which may also have implications for management of other cancers.
Method
A survey of management strategies for stage I seminoma patients was conducted in 2005 and repeated in 2009. TRISST opened in May 2008 and uses a factorial design to assess both frequency of surveillance (3 scans over 3 years vs 7 over 5 years) and the appropriate technology (CT vs MRI). Evaluation of screening logs provides evidence regarding acceptability of different strategies.
Results
The 2005 survey indicated that surveillance was offered to all, selected or no patients in the ratio 8:14:13, and schedules varied widely. Many clinicians expressed interest in trials assessing the efficacy of MRI and different scan frequencies. By April 2009, TRISST had 22 UK sites open to recruitment or applying for accreditation. Of 69 eligible patients screened, 36% have been recruited. The main reason for refusal is patients wanting adjuvant chemotherapy (25%). Only one patient did not want MRI.
Conclusion
Carboplatin, radiotherapy and surveillance are all management options available to stage I seminoma patients, but the latter has not been informed by randomised trials and there is no UK standard. TRISST results will inform decisions regarding this standard.
