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

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

Julia Heinzelbecker  1 , Stefanie Schmidt  2 , Julia Lackner  2 , Jonas Busch  3 , Carsten Bokemeyer  4 , Johannes Classen  5 , Annette Dieing  6 , Oliver Hakenberg  7 , Susanne Krege  8 , Alexandros Papachristofilou  9 , David Pfister  10 , Christian Ruf  11 , Hans Schmelz  12 , Heinz Schmidberger  13 , Rainer Souchon  14 , Christian Winter  15 , Friedemann Zengerling  16 , Sabine Kliesch  17 , Peter Albers  18 , Christoph Oing  4   19
Affiliations

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

Julia Heinzelbecker et al. World J Urol. 2022 Dec.

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.

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

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the study inclusion process for the systematic review according to PRISMA [9]
See this image and copyright information in PMC

References

    1. Gurney JK, Florio AA, Znaor A, et al. International trends in the incidence of testicular cancer: lessons from 35 years and 41 countries. Eur Urol. 2019;76:615–623. doi: 10.1016/j.eururo.2019.07.002. - DOI - PMC - PubMed
    1. Nigam M, Aschebrook-Kilfoy B, Shikanov S, Eggener S. Increasing incidence of testicular cancer in the United States and Europe between 1992 and 2009. World J Urol. 2015;33:623–631. doi: 10.1007/s00345-014-1361-y. - DOI - PubMed
    1. Rothermundt C, Thurneysen C, Cathomas R, et al. Baseline characteristics and patterns of care in testicular cancer patients: first data from the Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS) Swiss Med Wkly. 2018;148:w14640. doi: 10.4414/smw.2018.14640. - DOI - PubMed
    1. Kliesch S, Schmidt S, Wilborn D, et al. Management of germ cell tumours of the testis in adult patients. German clinical practice guideline part i: epidemiology, classification, diagnosis, prognosis, fertility preservation, and treatment recommendations for localized stages. Urol Int. 2021 doi: 10.1159/000510407. - DOI - PMC - PubMed
    1. Kliesch S, Schmidt S, Wilborn D, et al. Management of germ cell tumours of the testes in adult patients: german clinical practice guideline, part II—recommendations for the treatment of advanced, recurrent, and refractory disease and extragonadal and sex cord/stromal tumours and for the management of follow-up, toxicity, quality of life, palliative care, and supportive therapy. Urol Int. 2021 doi: 10.1159/000511245. - DOI - PMC - PubMed

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