Treatment of stage I seminoma
- Clair J Beard, MD
Clair J Beard, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
Testicular germ cell tumors (GCTs) can consist of one histologic pattern or represent a mix of multiple histologic types. Testicular GCTs are divided into two groups: pure seminoma and nonseminomatous GCTs (NSGCTs) [1,2]. Men with stage I seminoma have an excellent prognosis following radical inguinal orchiectomy. Therefore, treatment can be tailored to individual patient preferences.
The treatment approach for men with stage I seminoma is reviewed here. An overview of the management of testicular GCTs, the epidemiology, clinical manifestations, diagnosis, and staging of testicular GCTs, and the approach to patients with stage II and stage III seminoma are presented separately.
●(See "Treatment of stage II seminoma".)
- 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.
- http://www.nccn.org/professionals/physician_gls/pdf/testicular.pdf (Accessed on February 11, 2015).
- Stenning S, Oliver T, Mead B, Gabe R. Carboplatin in clinical stage I seminoma: a valuable option for patient management. J Clin Oncol 2011; 29:4210.
- Arvold ND, Catalano PJ, Sweeney C, et al. Physician and patient factors influencing management recommendations in stage I testicular seminoma: A survey among radiation oncologists in the United States (abstract 225). J Clin Oncol 2011; 29 Suppl 7:225.
- Yu HY, Madison RA, Setodji CM, Saigal CS. Quality of surveillance for stage I testis cancer in the community. J Clin Oncol 2009; 27:4327.
- 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.
- Mortensen MS, Lauritsen J, Gundgaard MG, et al. A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol 2014; 66:1172.
- Kollmannsberger C, Tandstad T, Bedard PL, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol 2015; 33:51.
- Hosni A, Warde P, Jewett M, et al. Clinical Characteristics and Outcomes of Late Relapse in Stage I Testicular Seminoma. Clin Oncol (R Coll Radiol) 2016; 28:648.
- Vesprini D, Chung P, Tolan S, et al. Utility of serum tumor markers during surveillance for stage I seminoma. Cancer 2012; 118:5245.
- Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol 2010; 28:3388.
- Oliver RT, Mason MD, Mead GM, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet 2005; 366:293.
- Oliver RT, Mead GM, Rustin GJ, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol 2011; 29:957.
- Oliver T, Dieckmann KP, Steiner H, et al. Pooled analyisis of phase 2 reports of 2 v 1 course of carboplatin as adjuvant for stage I seminoma (abstract). J Clin Oncol 2005; 23:395s.
- Dieckmann KP, Brüggeboes B, Pichlmeier U, et al. Adjuvant treatment of clinical stage I seminoma: is a single course of carboplatin sufficient? Urology 2000; 55:102.
- Reiter WJ, Brodowicz T, Alavi S, et al. Twelve-year experience with two courses of adjuvant single-agent carboplatin therapy for clinical stage I seminoma. J Clin Oncol 2001; 19:101.
- Steiner H, Höltl L, Wirtenberger W, et al. Long-term experience with carboplatin monotherapy for clinical stage I seminoma: a retrospective single-center study. Urology 2002; 60:324.
- Aparicio J, Germà JR, García del Muro X, et al. Risk-adapted management for patients with clinical stage I seminoma: the Second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol 2005; 23:8717.
- Aparicio J, García del Muro X, Maroto P, et al. Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol 2003; 14:867.
- Tandstad T, Ståhl O, Dahl O, et al. Treatment of stage I seminoma, with one course of adjuvant carboplatin or surveillance, risk-adapted recommendations implementing patient autonomy: a report from the Swedish and Norwegian Testicular Cancer Group (SWENOTECA). Ann Oncol 2016; 27:1299.
- Fischer S, Tandstad TR, Wheater M, et al. Outcome of men with relapse after adjuvant carboplatin for clinical stage I seminoma. J Clin Oncol 2016.
- Mead GM, Fossa SD, Oliver RT, et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. J Natl Cancer Inst 2011; 103:241.
- Wilder RB, Buyyounouski MK, Efstathiou JA, Beard CJ. Radiotherapy treatment planning for testicular seminoma. Int J Radiat Oncol Biol Phys 2012; 83:e445.
- Dosoretz DE, Shipley WU, Blitzer PH, et al. Megavoltage irradiation for pure testicular seminoma: results and patterns of failure. Cancer 1981; 48:2184.
- Fosså SD, Aass N, Kaalhus O. Radiotherapy for testicular seminoma stage I: treatment results and long-term post-irradiation morbidity in 365 patients. Int J Radiat Oncol Biol Phys 1989; 16:383.
- Zagars GK, Babaian RJ. Stage I testicular seminoma: rationale for postorchiectomy radiation therapy. Int J Radiat Oncol Biol Phys 1987; 13:155.
- Bamberg M, Schmidberger H, Meisner C, et al. Radiotherapy for stages I and IIA/B testicular seminoma. Int J Cancer 1999; 83:823.
- Willan BD, McGowan DG. Seminoma of the testis: a 22-year experience with radiation therapy. Int J Radiat Oncol Biol Phys 1985; 11:1769.
- Niazi TM, Souhami L, Sultanem K, et al. Long-term results of para-aortic irradiation for patients with stage I seminoma of the testis. Int J Radiat Oncol Biol Phys 2005; 61:741.
- Kiricuta IC, Sauer J, Bohndorf W. Omission of the pelvic irradiation in stage I testicular seminoma: a study of postorchiectomy paraaortic radiotherapy. Int J Radiat Oncol Biol Phys 1996; 35:293.
- Classen J, Schmidberger H, Meisner C, et al. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer 2004; 90:2305.
- Paly JJ, Efstathiou JA, Hedgire SS, et al. Mapping patterns of nodal metastases in seminoma: rethinking radiotherapy fields. Radiother Oncol 2013; 106:64.
- Fosså SD, Horwich A, Russell JM, et al. Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. J Clin Oncol 1999; 17:1146.
- Hanks GE, Peters T, Owen J. Seminoma of the testis: long-term beneficial and deleterious results of radiation. Int J Radiat Oncol Biol Phys 1992; 24:913.
- Jones WG, Fossa SD, Mead GM, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 2005; 23:1200.
- Krege S, Souchon R, Schmoll HJ, German Testicular Cancer Study Group. Interdisciplinary consensus on diagnosis and treatment of testicular germ cell tumors: result of an update conference on evidence-based medicine (EBM). Eur Urol 2001; 40:372.
- Bieri S, Rouzaud M, Miralbell R. Seminoma of the testis: is scrotal shielding necessary when radiotherapy is limited to the para-aortic nodes? Radiother Oncol 1999; 50:349.
- DIAGNOSIS AND INITIAL TREATMENT
- POSTSURGICAL MANAGEMENT
- Active surveillance
- - Surveillance protocol
- CT imaging
- Tumor markers
- Men who decline active surveillance
- - Adjuvant chemotherapy
- - Adjuvant radiation therapy
- - Treatment field
- - Dose
- Recurrent disease
- SUMMARY AND RECOMMENDATIONS