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.