The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options.
A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed.
Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%-21.1% for RT and of 0%-14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities.
RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation.
World journal of urology. 2021 Nov 15 [Epub ahead of print]
Julia Heinzelbecker, Stefanie Schmidt, Julia Lackner, Jonas Busch, Carsten Bokemeyer, Johannes Classen, Annette Dieing, Oliver Hakenberg, Susanne Krege, Alexandros Papachristofilou, David Pfister, Christian Ruf, Hans Schmelz, Heinz Schmidberger, Rainer Souchon, Christian Winter, Friedemann Zengerling, Sabine Kliesch, Peter Albers, Christoph Oing
Department of Urology and Paediatric Urology, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Saar, Germany. ., UroEvidence@Deutsche Gesellschaft Für Urologie, Berlin, Germany., Department of Urology, Vivantes Clinics am Urban, Berlin, Germany., II. Medical Clinic and Polyclinic, University Hospital Hamburg-Eppendorf, Hamburg, Germany., Department of Radiotherapy, Radiological Oncology and Palliative Medicine, St. Vincentius-Kliniken, Karlsruhe, Germany., Clinic for Internal Medicine-Hematology and Oncology, Vivantes Clinics Am Urban, Berlin, Germany., Urological Clinic and Polyclinic, University Hospital Rostock, Rostock, Germany., KEM, Protestant Hospital Essen-Mitte, Clinic for Urology, Pediatric Urology and Urological Oncology, Essen, Germany., Clinic of Radiotherapy and Radiation Oncology, University Hospital Basel, Basel, Switzerland., Department of Urology, University Hospital Cologne, Cologne, Germany., Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Ulm, Germany., Department of Urology, Bundeswehrkrankenhaus (German Federal Armed Forces Hospital), Koblenz, Germany., Clinic and Polyclinic for Radiooncology and Radiotherapy, University Hospital Mainz, Mainz, Germany., Department for Radiooncology, University Hospital Tübingen, Tübingen, Germany., Urologie Neandertal (Regional Joint Practice), Erkrath, Germany., Department of Urology, University Hospital Ulm, Ulm, Germany., Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University Hospital Münster, Münster, Germany., Department of Urology, University Hospital Düsseldorf, Düsseldorf, Germany.