Che Yue, Papachristofilou Alexandros
Klinik für Urologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland.
Klinik für Strahlentherapie und Radioonkologie, Universitätsspital Basel, Basel, Schweiz.
Urologie. 2025 Sep 2. doi: 10.1007/s00120-025-02672-9.
Stage IIA/B seminoma is cured in over 90% of cases with standard therapies (polychemotherapy, large-volume radiotherapy). However, these treatments are associated with potential late toxicities.
This article addresses current developments from a urological-surgical and radiotherapeutic perspective in the treatment of stage IIA/B seminoma. Current study results are presented, and possible developments are outlined.
Retroperitoneal lymphadenectomy (RLA) has the potential to offer a radiation- and chemotherapy-free treatment alternative. It was investigated in the recently published PRIMETEST, SEMS, and COTRIMS studies. Current clinical research focuses on the choice of template (unilateral vs. bilateral), the surgical approach (open vs. robotic), and the potential use of adjuvant chemotherapy after RLA (ongoing PRIMETEST II study). A combined, de-escalated chemoradiotherapy was evaluated in the SAKK 01/10 study and yielded very good results regarding recurrence-free survival and toxicity. Long-term results are still awaited, as are the results of the study SAKK 01/18.
IIA/B期精原细胞瘤采用标准疗法（多药化疗、大剂量放疗）治疗，90%以上的病例可治愈。然而，这些治疗方法存在潜在的晚期毒性。
本文从泌尿外科手术和放射治疗的角度探讨IIA/B期精原细胞瘤治疗的当前进展。介绍了当前的研究结果，并概述了可能的发展方向。
腹膜后淋巴结清扫术（RLA）有可能提供一种无需放疗和化疗的治疗选择。最近发表的PRIMETEST、SEMS和COTRIMS研究对其进行了调查。当前的临床研究重点在于模板的选择（单侧与双侧）、手术方式（开放手术与机器人手术）以及RLA术后辅助化疗的潜在应用（正在进行的PRIMETEST II研究）。SAKK 01/10研究评估了一种联合的降阶梯放化疗，在无复发生存率和毒性方面取得了非常好的结果。长期结果以及SAKK 01/18研究的结果仍有待观察。
