The long-term toxicities of chemotherapy and radiotherapy can represent a significant burden to testicular cancer survivors. Retroperitoneal lymph node dissection (RPLND) is an established treatment for testicular germ cell tumors with minimal late morbidity although little data exist on its efficacy in early metastatic seminoma. Surgery in early metastatic seminoma is a prospective phase II single-arm, multi-institutional trial of RPLND as first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy.
Twelve sites in the United States and Canada prospectively enrolled adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm). Open RPLND was performed by certified surgeons with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed.
A total of 55 patients were enrolled, with a median (IQR) largest clinical lymph node size of 1.6 cm (1.3-1.9). RPLND pathology demonstrated a median (IQR) largest lymph node size of 2.3 cm (0.9-3.5); nine patients (16%) were pN0, 12 (22%) pN1, 31 (56%) pN2, and 3 (5%) pN3. One patient received adjuvant chemotherapy. With a median (IQR) follow-up of 33 months (12.0-61.6), 12 patients experienced recurrence, with a 2-year RFS of 81% and a recurrence rate of 22%. Of the patients who experienced recurrence, 10 were treated with chemotherapy and two underwent additional surgery. At last follow-up, all patients who experienced a recurrence were disease-free and the 2-year overall survival was 100%. Four patients (7%) experienced short-term complications, and four patients experienced long-term complications including incisional hernia (1) and anejaculation (3).
RPLND is a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy and is associated with low long-term morbidity.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2023 Mar 13 [Epub ahead of print]
Siamak Daneshmand, Clint Cary, Timothy Masterson, Lawrence Einhorn, Nabil Adra, Stephen A Boorjian, Christian Kollmannsberger, Anne Schuckman, Alan So, Peter Black, Aditya Bagrodia, Eila Skinner, Mehrdad Alemozaffar, Timothy Brand, Scott Eggener, Phillip Pierorazio, Kelly Stratton, Lucia Nappi, Craig Nichols, Chunqiao Luo, Ming Li, Brian Hu
Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA., Department of Urology, Indiana University, Indianapolis, IN., Division of Hematology & Medical Oncology, Melvin & Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN., Department of Urology, Mayo Clinic, Rochester, MN., Division of Medical Oncology, BC Cancer, Vancouver, BC, Canada., Department of Urological Sciences, The Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX., Department of Urology, Stanford University, Stanford, CA., Department of Urology, Emory University Hospital, Atlanta, GA., Department of Urology, Madigan Army Medical Center, Tacoma, WA., Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IL., Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MA., Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK., Department of Population and Public Health Sciences, USC Norris Comprehensive Cancer Center, Los Angeles, CA., Department of Urology, Loma Linda University, Loma Linda, CA.