A risk-adapted strategy of radiotherapy and cisplatin-based chemotherapy in stage II seminoma: Results of a 20-year experience

Abstract

4571 Background: Indications for radiotherapy (RT) and chemotherapy (CT) in stage II seminoma are debated. From 1982 to 2001, the policy at Institut Gustave Roussy was to treat patients (pts) with stage IIA-IIB disease with external RT (35 Gy) targeting the retroperitoneal lymph nodes (+ the mediastinum and supra-clavicular area until 1992) and pts with IIB-IIC disease with cisplatin-based CT. In stage IIB, 3 cm was the typical larger tumor size selected for RT. Methods: We retrospectively reviewed 59 consecutive pts with stage II seminoma who were treated in our institution according to this policy. Results: Median age was 40 years (range: 23–61). Pts had stage IIA (n= 9), stage IIB (n=26), and stage IIC (n=24) disease. Among the 30 pts who received RT, 8, 20, and 2 had stage IIA, IIB, and IIC disease, respectively. Among the 29 patients who received CT, 0, 7, and 22 had stage IIA, IIB, and IIC disease, respectively. They received EP (n=20), BEP (n=3), HOP (n=3), PVB (n=2), and VAB-6 (n=1). With a median follow-up of 7 years (range 0–21), 18 relapses occurred (31%), including 9 cases treated with RT (30%) and 9 others with CT (31%). The 5-year relapse-free survival was 69% (CI 95%: 56–79). All relapses but one was salvaged with CT ± followed by surgical resection of residual masses and only 1 pt died of seminoma. The 5-year overall survival is 98% (CI 95%: 91–100). Four patients developed a second cancer: 3 had received RT and their second cancer occurred in the radiation field (colo-rectal carcinoma, oesophageal cancer, and medullary thyroid carcinoma) and 1 pt had received CT (colo-rectal carcinoma). Conclusions: The overall outcome of patients with stage II seminoma treated according to this risk-adapted strategy is excellent. To reduce the risk of relapse, 1) indications for CT could be extended to all stage IIB lesions and 2) post-CT residual masses could be evaluated with PET scan to identify pts likely to have active disease and therefore to select them for additional treatment. No significant financial relationships to disclose.