Department of Urology and Paediatric Urology, Saarland University Medical Centre and Saarland University Faculty of Medicine, Homburg, Saar, Germany.
UroEvidence@Deutsche Gesellschaft Für Urologie, Berlin, Germany.
World J Urol. 2022 Dec;40(12):2829-2841. doi: 10.1007/s00345-021-03873-5. Epub 2021 Nov 15.
The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options.
A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed.
Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%-21.1% for RT and of 0%-14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities.
RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation.
临床分期（CS）IIA/IIB 精原细胞瘤的最佳治疗方法仍存在争议。我们评估了当前的治疗选择。
进行了系统评价。仅纳入 2010 年 1 月至 2021 年 2 月发表的随机临床试验和对照研究。检索词包括：精原细胞瘤、CS IIA、CS IIB 和治疗。结局参数包括复发率（RR）、无复发生存（RFS）、总生存（OS）和癌症特异性生存（CSS）。此外，还分析了急性和长期副作用，包括继发恶性肿瘤（SMs）。
共确定了 7 项对照研究（1 项前瞻性和 6 项回顾性研究），共纳入 5049 例患者（CS IIA：2840 例，CS IIB：2209 例）。应用的治疗方式为放疗（RT）（n=3049；CS IIA：1888 例，CSIIB：1006 例，不详：155 例）和化疗（CT）或无 RT（n=2000；CS IIA：797 例，CS IIB：1074 例，不详：129 例）。在 CS IIA 中，RT 的 RR 为 0%至 4.8%，CT 的 RR 为 0%。关于 CS IIB，RT 的 RR 为 9.5%-21.1%，CT 的 RR 为 0%-14.2%。5 年 OS 率为 90%至 100%。只有两项研究报告了与治疗相关的毒性。
RT 和 CT 是 CS IIA/B 精原细胞瘤最常用的治疗方法。在 CS IIA 精原细胞瘤中，RT 和 CT 后的 RR 相似。然而，在 CS IIB 中，CT 似乎更有效。CS IIA/B 精原细胞瘤的生存率非常高。因此，长期毒性和 SMs 是重要的生存问题。目前正在进行前瞻性研究替代治疗方法，如腹膜后淋巴结清扫术（RPLND）或剂量降低的序贯 CT/RT。
