Magnetic Resonance Imaging and Computed Tomography in Patients With Stage I Seminoma of the Testicle

RATIONALE: Imaging procedures, such as MRI and CT scan, may find recurrent cancer. It is not yet known which MRI or CT scan schedule is more effective in finding recurrent cancer. PURPOSE: This randomized phase III trial is comparing four different MRI and CT scan schedules in patients with stage I seminoma of the testicle.

OBJECTIVES: To assess whether a reduced computed tomography (CT) schedule or magnetic resonance imaging (MRI) could be used as safe and effective alternatives to standard CT-based surveillance in the management of patients with stage I seminoma of the testis. OUTLINE: This is a multicenter study. Patients are randomized to 1 of 4 surveillance arms. Arm I: Patients undergo computed tomography (CT) scan of the abdomen/retroperitoneum* at 6, 12, 18, 24, 36, 48, and 60 months in the absence of disease progression. Arm II: Patients undergo CT scan of the abdomen/retroperitoneum* at 6, 18, and 36 months in the absence of disease progression. Arm III: Patients undergo magnetic resonance imaging (MRI) of the abdomen/retroperitoneum* at 6, 12, 18, 24, 36, 48, and 60 months in the absence of disease progression. Arm IV: Patients undergo MRI of the abdomen/retroperitoneum* at 6, 18, and 36 months in the absence of disease progression. NOTE: *Patients with a history of ipsilateral inguino-scrotal surgery also undergo imaging of the pelvis. Patients complete questionnaires at baseline and periodically during study to assess health-related quality of life; utilization and cost of healthcare services (including the cost of CT- or MRI-based surveillance and the management of any recurrence); and acceptability of allocated scanning schedule. Patients are followed every 3 months for 2 years, every 4 months for 1 year, and then every 6 months for 3 years.

Difference in mean abdominal mass size at relapse between computed tomography (CT) scan and magnetic resonance imaging (MRI)

Prospective identification of first modality to detect relapse (patient symptom, clinical examination, tumor marker, chest x-ray, cross-sectional image)

DISEASE CHARACTERISTICS: Histologically confirmed seminoma of the testis Stage I disease, as determined by clinical examination and CT scan of the chest, abdomen, and pelvis No evidence of any non-seminoma germ cell tumor elements Has undergone orchidectomy within the past 8 weeks Normal serum alpha-fetoprotein pre-orchidectomy and at study randomization Normal serum beta human chorionic gonadotrophin at study randomization (may have been elevated pre-orchidectomy) Not planning to undergo adjuvant therapy PATIENT CHARACTERISTICS: Able to attend regular surveillance No other malignancy within the past 10 years expect successfully treated nonmelanoma skin cancer No contraindication to MRI (i.e., ferrous metal implants of any type, cardiac pacemaker or defibrillator, or history of injury by metal fragments) PRIOR CONCURRENT THERAPY: See Disease Characteristics

Joffe JK, Cafferty FH, Murphy L, Rustin GJS, Sohaib SA, Gabe R, Stenning SP, James E, Noor D, Wade S, Schiavone F, Swift S, Dunwoodie E, Hall M, Sharma A, Braybrooke J, Shamash J, Logue J, Taylor HH, Hennig I, White J, Rudman S, Worlding J, Bloomfield D, Faust G, Glen H, Jones R, Seckl M, MacDonald G, Sreenivasan T, Kumar S, Protheroe A, Venkitaraman R, Mazhar D, Coyle V, Highley M, Geldart T, Laing R, Kaplan RS, Huddart RA; TRISST Trial Management Group and Investigators. Imaging Modality and Frequency in Surveillance of Stage I Seminoma Testicular Cancer: Results From a Randomized, Phase III, Noninferiority Trial (TRISST). J Clin Oncol. 2022 Aug 1;40(22):2468-2478. doi: 10.1200/JCO.21.01199. Epub 2022 Mar 17.