A risk-adapted strategy of radiotherapy or cisplatin-based chemotherapy in stage II seminoma.

Objectives: Indications for radiotherapy and chemotherapy in stage II seminoma are currently debated. Materials and methods: Since1980, the policy at Institut Gustave Roussy was to treat patients with stage IIA-B disease with external radiotherapy and patients with stage JIB-C with cisplatin-based chemotherapy. In stage JIB disease, 3 cm was the usual tumor size threshold above which individual patients were considered for chemotherapy. Results: During the period 1980-2001, 67 patients with stage II seminoma were treated: stage IIA (n = 5), stage JIB (n = 31), and stage TIC (71 = 31). The median age was 40 years (range: 23-64). Among 37 patients who received radiotherapy, 5, 28, and 4 had a stage IIA, JIB, and TIC, respectively. Among 30 patients who received chemotherapy, 27 had a stage IIC. With a median follow-up of 9.4 years, 19 relapses (28%) occurred, including 11 and 8 cases treated with radiotherapy (30%) and chemotherapy (27%), respectively. The 5-year relapse-free survival was 71% (95% CI: 59-80). All but three relapses were salvaged with chemotherapy followed in selected cases by surgical resection of residual masses. Only 3 patients died of seminoma. The 5-year overall survival rate is 97% (95% CI: 89-99). Five patients subsequently developed a non-germ-cell second cancer, which occurred within the radiation field in 3 cases. Conclusion: With an overall survival rate of 97%, the overall outcome of patients with stage II seminoma managed according to this risk-adapted strategy is good. The possibility of extending the indications for chemotherapy to selected stage BB seminoma patients needs to be further evaluated as potentially beneficial in terms of relapse risk. (C) 2013 Elsevier Inc. All rights reserved.