Cost-effectiveness of posttreatment surveillance after radiation therapy for early stage seminoma

✍ Scribed by Thomas A. Buchholz; Thomas L. Walden; Bradley R. Prestidge

• Publisher: John Wiley and Sons
• Year: 1998
• Tongue: English
• Weight: 234 KB
• Volume: 82
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/(sici)1097-0142(19980315)82:6<1126::aid-cncr17>3.0.co;2-8

✦ Synopsis

II seminoma (based on the Royal Marsden staging system) received paraaortic and pelvic lymph node radiation after radical orchiectomy. Patient records were 1 Department of Radiation Oncology, M. D. Anreviewed and patients surveyed to determine the tests ordered for posttreatment derson Cancer Center, Houston, Texas. surveillance. 2 Radiation Oncology Branch, National Cancer RESULTS. With a median follow-up of 55 months, there were 2 recurrences among Institute, Bethesda, Maryland. the 58 patients. Eight-year actuarial disease free survival was 93%, with 100% 3 Division of Radiation Oncology, Wilford Hall overall survival. Information concerning follow-up screening was available for 56 Medical Center, Lackland AFB, Texas. patients. The follow-up tests ordered included 842 physical examinations, 815 chest X-rays, 839 serum markers, 250 computerized tomography scans, and 112 abdominal plain films. The total cost of these examinations according to 1996 private sector charges and 1996 Medicare reimbursement rates, respectively, was $602,673.01 (average $10,762.02 per patient) and $282,746.52 (average $5049.05 per patient). The two patients who experienced recurrence were diagnosed independently of their posttreatment screening program. One patient recurred 7.5 months after his original diagnosis with an isolated spinal cord compression. The second patient had a mediastinum recurrence ú 6 years after treatment. At last followup, both patients were disease free after salvage treatment.

CONCLUSIONS.

Patients with early stage seminoma treated with orchiectomy and radiation have excellent disease free survival rates. The cost of the surveillance program studied does not appear to be justifiable.