Effectiveness and safety of salvage therapy in residual retroperitoneal masses in advanced testicular seminoma: A systematic review

Objective: To determine the effectiveness and safety of surgery, chemotherapy, or radiotherapy for treating post-chemotherapy residual mass in advanced testicular seminoma in terms of overall survival and progression-free survival. Methods: We conducted a search strategy in MEDLINE (OVID), EMBASE, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We assessed the risk of bias and performed this review according to the recommendations of the Cochrane Collaboration and following the PRISMA Statement. Results: Within the included studies, there are 239 patients with germ cell carcinoma, all in an advanced stage of the disease (IIa,IIb, IIc, or III) and where 100% are pure seminomas. The interventions were radiation therapy, immediate resection after the first positive PET, other salvage therapy as second or third chemotherapy for residual masses, and a high dose of chemotherapy and autologous stem cell transplantation. The median progression-free survival in the observation arm was 39.4 months in the very high-risk group and 40 months in the high-risk group, whereas it was not reached for the radiotherapy arm. Also, a new chemotherapy scheme had progression-free survival in a 10-year follow-up of 94.2%. The overall survival for the high-risk group radiotherapy versus observation was not significant ( p = 0.47), similar to the very high-risk subgroup ( p = 0.42). The reported complications are due to surgical management and chemotherapy toxicity. Conclusion: Evidence on the management of post-chemotherapy residual retroperitoneal masses in advanced seminoma is limited and of low certainty. Available studies are few and heterogeneous, precluding definitive conclusions regarding progression-free or overall survival. Current findings support individualized treatment decisions, while further prospective studies are needed to better define optimal management strategies and long-term outcomes.