Therapy of clinical stage IIA and IIB seminoma: a systematic review.
World J Urol
; 40(12): 2829-2841, 2022 Dec.
Article
in En
| MEDLINE
| ID: mdl-34779882
ABSTRACT
PURPOSE:
The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options.METHODS:
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.RESULTS:
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.CONCLUSIONS:
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Testicular Neoplasms
/
Neoplasms, Second Primary
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Seminoma
Type of study:
Observational_studies
/
Risk_factors_studies
/
Systematic_reviews
Limits:
Humans
/
Male
Language:
En
Journal:
World J Urol
Year:
2022
Document type:
Article
Affiliation country: