Advanced Seminoma: The Role of Chemotherapy and Adjunctive Surgery

STUDY OBJECTIVE: To determine the effectiveness of chemotherapy and adjunctive surgery in managing patients with advanced seminoma. DESIGN: Nonrandomized prospective clinical trial of chemotherapy in a cohort of patients with advanced seminoma. SETTING: Referral cancer hospital. PATIENTS: Consecutive sample of 62 patients with primary extragonadal, stage IIC (greater than 5-cm retroperitoneal adenopathy) and stage III seminoma; 45 patients were previously untreated, 13 had received radiotherapy, and 4 had previously received radiotherapy and chemotherapy. INTERVENTION: Cisplatin-based chemotherapy (100 to 120 mg/m2 body surface area per cycle of treatment); 45 patients received vinblastine, bleomycin, cisplatin, dactinomycin, and cyclophosphamide; 15, etoposide and cisplatin; and 2, both regimens. MEASUREMENTS AND MAIN RESULTS: Fifty-three of the sixty (88%) evaluable patients achieved a complete remission, and only 6 patients had relapses. Fifty-three of the sixty-two patients (85%) remain alive and disease-free. The regimen of etoposide and cisplatin was equivalent to regimens using more drugs. An elevated level of human chorionic gonadotropin at the initiation of treatment was associated with a worse prognosis. CONCLUSIONS: Cisplatin-based chemotherapy is effective treatment for patients with extragonadal, stage IIC, and stage III seminoma and should be considered as initial therapy.