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

Abstract

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.

The prognostic impact of treatment centralization in patients with testicular germ cell tumors: analysis of hospital-based cancer registry data in Japan

“…In our histological analysis, we showed that survival rates in patients with stage I seminoma were comparable to previously reported results [15][16]. However, the results for patients with stage II were slightly worse than previously reported [17][18][19]. This discrepancy may be due in part to the relatively large proportion of elderly patients with stage II seminoma enrolled in this study.…”

Primary Retroperitoneal Lymph Node Dissection for Clinical Stage II A/B Seminomas: A Systematic Review and Meta-Analysis

“…Direct comparative studies between chemotherapy and radiation therapy are scarce and primarily confined to retrospective analyses. Although none of these studies have demonstrated significant differences in survival rates, a noticeable trend in relapse was observed in patients diagnosed with CS IIB who underwent radiation therapy ( 30 – 32 ).…”

Serum Levels of MicroRNA-371a-3p (M371) Can Predict Absence or Presence of Vital Disease in Residual Masses After Chemotherapy of Metastatic Seminoma

“…Cisplatin-based chemotherapy can provide a cure in the majority of patients with metastatic seminoma (1)(2)(3). Yet in about 73% of cases, radiological restaging will reveal only partial remission (PR) at the completion of treatment, which denotes a persisting mass of reduced size at the metastatic site (4).…”