Clinical Outcomes of Stage IIA/IIB Seminoma Treated With Radiation Therapy and Chemotherapy: Should Regional Therapy be Considered the Preferred Treatment Approach?

Abstract

Purpose: The optimal management of patients with de novo clinical stage IIA/B (CSIIA/B) or relapsed CSIIA/B (Rel-CSIIA/B) seminoma remains debated because of a lack of randomized evidence. Here, we sought to evaluate outcomes after radiation therapy and chemotherapy in this setting.

Methods and materials: A prospectively maintained single-institutional database was retrospectively queried for patients diagnosed between 1995 and 2016 with de novo or Rel-CSIIA/B. Patients with Rel-CSIIA/B were managed similarly to de novo CSIIA/B. All patients were reviewed by the multidisciplinary team. Although the preferred management policy was radiation therapy, the treatment decision was individualized at the physician/patient level.

Results: There were 153 patients: 67 had de novo CSIIA/B (IIA-32, IIB-35) and 86 patients had Rel-CSIIA/B seminoma (IIA-51, IIB-35). Of the total, 120 patients (78%) received radiation therapy (IIA-78, IIB-42) and 33 (22%) received platinum-based chemotherapy (IIA-5, IIB-28). Median follow-up was 7.1 years (interquartile range, 4.3-9.9 years). Eleven patients (IIA-9/78, IIB-2/42) relapsed after radiation therapy and 1 patient (IIB) relapsed after chemotherapy, corresponding to 5-year relapse rates of 10% (95% CI 6%-18%) for radiation therapy and 3% (95% CI, 0%-23%) for chemotherapy. All 12 patients who relapsed were treated with subsequent chemotherapy.

Conclusion: Radiation therapy and chemotherapy result in excellent oncologic outcomes for patients with de novo or Rel-CSIIA/B seminoma. All patients should be informed about both management options. However, radiation therapy with its favorable acute toxicity profile could be considered the treatment of choice in most patients.