Chemotherapy As an Alternative to Radiotherapy in the Treatment of Stage IIA and IIB Testicular Seminoma: A Spanish Germ Cell Cancer Group Study

Abstract

Chemotherapy is a highly effective and well-tolerated treatment for patients with stage IIA or IIB seminoma and represents an available alternative that could avoid some of the serious late effects associated with radiotherapy. Further studies focusing on long-term toxicities of different treatment modalities are needed.

Two Cycles of Cisplatin-Based Chemotherapy for Low-Volume Stage II Seminoma: Results of a Retrospective, Single-Center Case Series

“…These results were confirmed by Garcia-del-Muro et al [4], who assigned 72 patients with pure seminoma to 4 cycles of cisplatin/etoposide or 3 PEB cycles with an overall 5-year progression-free and overall survival rate of 90 and 95%, respectively, at a median follow-up of 71.5 months. Giannis et al [28] also concluded that patients with low-volume metastatic stage IIA and IIB seminoma can be treated by 4 cycles of PEB instead of radiotherapy with the risk of diverse toxicity effect.…”

“…Regarding the published EAU Guidelines on Testicular Cancer 2011, radiotherapy is considered the standard treatment approach in low-volume metastatic seminoma with a radiation dose of 30 Gy (stage IIA) or 36 Gy (stage IIB) and an extended radiation field from the para-aortic region to the ipsilateral iliac field [3]. On the other hand, 4 cycles of etoposide and cisplatin or 3 cycles of cisplatin, etoposide and bleomycin (PEB) have been shown to be highly effective and well tolerated in patients with stage IIA or IIB seminoma with a 5-year progression-free survival of 100% (stage IIA) and 87% (stage IIB) similar to radiotherapy [4]. Unfortunately, cisplatin-based chemotherapy is also associated with dose-depending long-term side effects like peripheral neuropathy and Raynaud phenomenon (RP) as well as gonadal damage in approximately 20–30% of patients following standard-dose therapy [5,6].…”

Clinical Stage IIA-IIC Seminoma: Radiation Therapy versus Systemic Chemotherapy versus Retroperitoneal Lymph Node Dissection

“…A recent study from the Swedish Norwegian Testicular Cancer Study Group reported 3 relapses among 29 irradiated stage IIA patients (10.9%), albeit with a suboptimal dose of 27 Gy, compared with no relapses after cisplatin-based CT [11]. In addition, in a study of the Spanish Germ Cell Cancer Group, a 5-year progression-free survival rate of 100% was observed for 18 CSIIA patients treated with either EP or BEP [12]. In contrast, the retrospective analyses of the US National Cancer Data Base showed an improved 5-year survival rate of 99.0% (95% confidence interval (CI) 98.2-99.8) with RT compared with 93.0% (95% CI 89.0-97.0) with CT [13].…”

“…Alternatively, paraaortic and ipsilateral iliac field RT of 36 Gy in 2-Gy fractions can be applied in low-volume disease. 1 population-based study with 54 stage CSIIB patients reported a 5-year progression-free survival rate of 87% with CT [12]. After a median follow-up time of 71.5 months, 6 patients experienced relapse, and 1 of these patients died as a result of seminoma [12].…”

Diagnosis and management of testicular cancers

“…11 Four cycles of EP is an acceptable alternative to three cycles of BEP. are divided into low risk or high risk depending on the presence of vascular invasion (VI).…”