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. 2022 Aug;67(3):126-128.
doi: 10.1177/00369330221099619. Epub 2022 May 4.

Management of stage II seminoma: a contemporary UK perspective

Constantine Alifrangis  1   2   3 , David L Nicol  4 , Jonathan Shamash  1 , Prabhakar Rajan  5   6   7   8 ; National Cancer Research Institute Teenage and Young Adult and Germ Cell Tumour Research Group
Affiliations

Management of stage II seminoma: a contemporary UK perspective

Constantine Alifrangis et al. Scott Med J. 2022 Aug.

Abstract

Background and aims: Testicular Germ Cell Tumours (TGCTs) are the commonest young adult male cancer, with excellent survival outcomes even with metastatic disease. Chemotherapy, radiotherapy, and surgery are international guideline-dictated standard of care (SOC) treatments for International Germ Cell Cancer Collaborative Group (IGCCCG) "good risk" TGCT, but are associated with significant toxicities. Therapy de-escalation aims to reduce treatment morbidity whilst preserving cure rates, and has been adopted by some centres for stage IIA/B seminoma. Here, we report on the contemporary UK treatment landscape for stage IIA/B seminoma.

Methods: A questionnaire-based survey of NHS England-designated specialist cancer centres hosting supra-regional specialist multi-disciplinary team (sMDT) services (n = 13) as well those within NHS Scotland, NHS Wales and Health and Social Care Northern Ireland. Respondents were asked to order preferences of SOC and therapy de-escalation treatments for stage IIA/B seminoma.

Results: We identified significant geographical heterogeneity in treatment preferences. Whilst up to a third of centres have adopted a treatment de-escalation regimen, the majority deliver combination chemotherapy or radiotherapy.

Conclusion: A wider recognition of UK treatment heterogeneity and consideration of therapy de-escalation strategies at supra-regional sMDTs will increase stage IIA/B seminoma treatment options as part of clinical trials with oncological and quality of life endpoints.

Keywords: Seminoma; chemotherapy; radiotherapy; retroperitoneal lymph node dissection; treatment de-escalation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Results of UK national survey of clinician treatment preferences for stage IIA/B seminoma at specialist centres for (A) Stage IIA and (B) Stage IIB seminoma.
See this image and copyright information in PMC

References

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Supplementary concepts