Therapy of clinical stage IIA and IIB seminoma: a systematic review

World J Urol. 2022 Dec;40(12):2829-2841. doi: 10.1007/s00345-021-03873-5. Epub 2021 Nov 15.


Purpose: The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: CS IIA/B; Seminoma; Systematic review; Testicular cancer; Toxicity; Treatment.

Publication types

  • Systematic Review

MeSH terms

  • Humans
  • Male
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Neoplasms, Second Primary* / pathology
  • Prospective Studies
  • Retrospective Studies
  • Seminoma* / drug therapy
  • Seminoma* / radiotherapy
  • Testicular Neoplasms* / drug therapy
  • Testicular Neoplasms* / radiotherapy