PURPOSE: Viable seminoma encountered at postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for pure testicular seminoma is rare due to the chemosensitivity of this germ cell tumor (GCT).
The purpose of this study is to define the natural history of viable seminoma at PC-RPLND.
MATERIALS AND METHODS: The Indiana University Testis Cancer Database was queried from 1988 to 2011 to identify all patients with primary testicular or retroperitoneal pure seminoma and who were found to have pure seminoma at PC-RPLND. Clinical characteristics were reviewed. Survival analysis was performed.
RESULTS: 36 patients met the inclusion criteria. All patients received standard first-line cisplatin-based chemotherapy and 17 received salvage chemotherapy. The decision to proceed to RPLND was based on enlarging retroperitoneal mass and/or positron emission positivity in the majority of cases. Seven patients had undergone previous RPLND. Additional surgical procedures were required in 19 patients in order to achieve a complete resection. The 5-year cancer specific survival (CSS) was 54%. However, only 9 of 36 patients remained continuously free of disease and 4 of these patients received adjuvant chemotherapy. The mean time from PC-RPLND to death was 6.9 months. Second line chemotherapy, reoperative RPLND, and earlier era of treatment were associated with poorer CSS.
CONCLUSION: 36 patients with pure seminoma were found to have viable pure seminoma at PC-RPLND. While the 5-year CSS was 54%, these surgeries are technically demanding and only a minority of patients achieve durable cure from surgery alone.
Written by:
Rice KR, Beck SD, Bihrle R, Cary KC, Einhorn LH, Foster RS. Are you the author?
Indiana University School of Medicine Department of Urology, Indianapolis, Indiana; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana.
Reference: J Urol. 2014 May 7. pii: S0022-5347(14)03513-7.
doi: 10.1016/j.juro.2014.04.097
PubMed Abstract
PMID: 24813309
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