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

Abstract

Background: To report on the oncological outcome and toxicity of patients treated with 2 cycles of cisplatin-based chemotherapy for low-volume metastatic stage II seminoma. Methods: We retrospectively identified a case series of 15 patients with seminoma stage IIA (26.7%) and IIB (73.3%) who underwent chemotherapy consisting of 2 cycles of cisplatin, etoposide and bleomycin (PEB) (cisplatin 20 mg/m² on days 1–5, etoposide 100 mg/m² on days 1–5, bleomycin 30 mg on days 1, 8 and 15) according to patient preference (refusing a 3rd cycle of PEB) or institutional practice in the last decades. Complete staging before chemotherapy was available in all patients. Patient age, the side and diameter of the primary tumor, the size of the lymph nodes before and after chemotherapy, acute and late toxicity of chemotherapy, the incidence of second malignancies, the relapse-free rate and cancer-specific mortality were recorded. Results: Chemotherapy was well tolerated and no episode of febrile neutropenia occurred. Thrombocytopenia grade 4 was not seen in any patient, while leukopenia grade 4 was observed in 4 (26.6%) patients. The mean (range) lymph node size decreased significantly from 2.54 cm (1.1–4.0) before chemotherapy to 0.75 cm (0.4–2.2) after chemotherapy (p < 0.001). After a median (range) follow-up of 60 (13–185) months, no patient had relapsed, no patient had died as a result of seminoma and second malignancy was seen in only 1 (6.6%) patient. Conclusions: These excellent long-term results from a retrospective case series of 2 cycles of PEB in stage IIA/IIB seminoma patients represent a hint for further research with a view to reducing treatment burden. However, these incidental findings should be studied in prospective trials prior to drawing any conclusions.

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

“…Consequently, four cycles of EP may be considered in patients where Bleomycin has to be omitted, which is also the established approach for advanced metastatic germ cell tumors with a favorable IGC-CCG risk profile [6,8]. The optimal number of cycles of BEP remains controversial since retrospective analyses of either four or two cycles of BEP also reported a 0% RR [37,38]. Three to four cycles of Carboplatin AUC7, is not equally effective compared to cisplatin-based combination CT with higher RRs reported in a prospective study by Krege et al [34].…”

Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma

“…Although representing a small sample size, the data compare favorably with the recurrence rates seen after EBRT and CT (Table 2). 11,12,17,18,[20][21][22][23][24][25][26][27] Most studies have examined the recurrence rate after EBRT, which has been 0% to 17%. The outcomes after cisplatin-based CT, although also of smaller sample sizes, have been favorable.…”

Germ Cell Tumor Targeting Chemotherapy in Gastric Adenocarcinoma with an Endodermal Sinus Tumor Component: A Case Report

“…BEP is the classic regimen for general germ cell tumors [7]. After four cycles of BEP, the size of the necrotic mass at S7-S8 was decreased and the solid portion of necrotic mass was improved (fig.…”