Treatment of stage II seminoma
- Clair J Beard, MD
Clair J Beard, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- William K Oh, MD
William K Oh, MD
- Section Editor — Testicular Cancer
- Professor of Medicine
- Mount Sinai School of Medicine
- Chief, Division of Hematology Oncology
- Tisch Cancer Institute
Testicular cancer is the most common solid malignancy affecting males aged 15 to 35 years, although these tumors only account for approximately 1 percent of all cancers in men . Germ cell tumors (GCTs), which account for 95 percent of testicular cancers, are one of the most curable solid neoplasms due to treatment advances that began in the late 1970s.
GCTs can consist of one histologic pattern or a mix of multiple histologic types. Testicular GCTs are divided into two groups:
●Pure seminoma (ie, no nonseminomatous elements), which constitute approximately 60 percent of GCTs [2,3].
●Nonseminomatous GCTs (NSGCTs), which may include elements of seminoma along with one or more other histologic types.
Clinical stage II disease is defined by the presence of pure seminoma in the orchiectomy specimen and imaging studies of the abdomen and pelvis that show positive regional lymph nodes (table 1 and table 2). Positive nodes are those that measure at least 10 mm on the short axis of cross-sectional imaging. Other potential sites of metastasis, such as the chest, are free of disease. About 15 percent of patients with seminoma have stage II disease at presentation .
- Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017.
- Groll RJ, Warde P, Jewett MA. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol 2007; 64:182.
- Warde P, Gospodarowicz M. Evolving concepts in stage I seminoma. BJU Int 2009; 104:1357.
- Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol 2011; 22:808.
- Willan BD, McGowan DG. Seminoma of the testis: a 22-year experience with radiation therapy. Int J Radiat Oncol Biol Phys 1985; 11:1769.
- Slawson RG. Radiation therapy for germinal tumors of the testes. Cancer 1978; 42:2216.
- Lindeman GJ, Tiver KW. Management of testicular seminoma at Westmead Hospital from 1980 to 87. Aust N Z J Surg 1991; 61:211.
- Mackey JR, Venner P. Seminoma with isolated central nervous system relapse, and salvage with craniospinal irradiation. Urology 1998; 51:1043.
- Schmoll HJ, Jordan K, Huddart R, et al. Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v140.
- Wood L, Kollmannsberger C, Jewett M, et al. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19.
- National Comprehensive Cancer Network guidelines available online at: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
- Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol 2003; 21:1101.
- Chung PW, Gospodarowicz MK, Panzarella T, et al. Stage II testicular seminoma: patterns of recurrence and outcome of treatment. Eur Urol 2004; 45:754.
- Tandstad T, Smaaland R, Solberg A, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group. J Clin Oncol 2011; 29:719.
- Schmoll HJ, Souchon R, Krege S, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15:1377.
- Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ. Radiotherapy treatment planning for testicular seminoma. Int J Radiat Oncol Biol Phys 2012; 83:e445.
- Krege S, Boergermann C, Baschek R, et al. Single agent carboplatin for CS IIA/B testicular seminoma. A phase II study of the German Testicular Cancer Study Group (GTCSG). Ann Oncol 2006; 17:276.
- Garcia-del-Muro X, Maroto P, Gumà J, et al. Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study. J Clin Oncol 2008; 26:5416.
- International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group. J Clin Oncol 1997; 15:594.
- Fosså SD, Borge L, Aass N, et al. The treatment of advanced metastatic seminoma: experience in 55 cases. J Clin Oncol 1987; 5:1071.
- Loehrer PJ Sr, Birch R, Williams SD, et al. Chemotherapy of metastatic seminoma: the Southeastern Cancer Study Group experience. J Clin Oncol 1987; 5:1212.
- Abratt RP, McAdam GL, Pontin AR, et al. Primary chemotherapy for stage 2 testis cancer. S Afr J Surg 1997; 35:203.
- Peckham MJ, Horwich A, Hendry WF. Advanced seminoma: treatment with cis-platinum-based combination chemotherapy or carboplatin (JM8). Br J Cancer 1985; 52:7.
- Flechon A, Bompas E, Biron P, Droz JP. Management of post-chemotherapy residual masses in advanced seminoma. J Urol 2002; 168:1975.
- Puc HS, Heelan R, Mazumdar M, et al. Management of residual mass in advanced seminoma: results and recommendations from the Memorial Sloan-Kettering Cancer Center. J Clin Oncol 1996; 14:454.
- De Santis M, Bokemeyer C, Becherer A, et al. Predictive impact of 2-18fluoro-2-deoxy-D-glucose positron emission tomography for residual postchemotherapy masses in patients with bulky seminoma. J Clin Oncol 2001; 19:3740.
- De Santis M, Becherer A, Bokemeyer C, et al. 2-18fluoro-deoxy-D-glucose positron emission tomography is a reliable predictor for viable tumor in postchemotherapy seminoma: an update of the prospective multicentric SEMPET trial. J Clin Oncol 2004; 22:1034.
- Rioja J, Rodríguez-Fraile M, Lima-Favaretto R, et al. Role of positron emission tomography in urological oncology. BJU Int 2010; 106:1578.
- Duchesne GM, Stenning SP, Aass N, et al. Radiotherapy after chemotherapy for metastatic seminoma--a diminishing role. MRC Testicular Tumour Working Party. Eur J Cancer 1997; 33:829.
- Hori K, Uematsu K, Yasoshima H, et al. Testicular seminoma with human chorionic gonadotropin production. Pathol Int 1997; 47:592.
- Mirimanoff RO, Sinzig M, Krüger M, et al. Prognosis of human chorionic gonadotropin-producing seminoma treated by postoperative radiotherapy. Int J Radiat Oncol Biol Phys 1993; 27:17.
- Weissbach L, Bussar-Maatz R, Löhrs U, et al. Prognostic factors in seminomas with special respect to HCG: results of a prospective multicenter study. Seminoma Study Group. Eur Urol 1999; 36:601.
- Motzer RJ, Bosl GJ, Geller NL, et al. Advanced seminoma: the role of chemotherapy and adjunctive surgery. Ann Intern Med 1988; 108:513.
- Mencel PJ, Motzer RJ, Mazumdar M, et al. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J Clin Oncol 1994; 12:120.
- Herman JG, Sturgeon J, Gospodarowicz M, et al. A prospective clinical trial for testicular seminoma and serum markers. Am J Clin Oncol 1983; 6:153.
- Oliver RT, Lore S, Ong J. Alternatives to radiotherapy in the management of seminoma. Br J Urol 1990; 65:61.