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Contemporary Management of Stage I and II Seminoma

  • Testis and Penile Cancer (M Manoharan and J Sheinfeld, Section Editors)
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Abstract

Seminoma represents about 60 % of all testicular germ cell tumors. At presentation about 80 % of patients have stage I and about 15 % have stage II disease. The last three decades have seen a substantial change in the philosophy of management with the success of surveillance as a strategy to minimize unnecessary treatment, recognition of the late effects of radiation therapy, and the success of cisplatin-based chemotherapy as curative treatment either in the first-line or salvage setting. Overall, in stage I disease where 80–85 % are cured with orchiectomy alone, efforts now are directed at reducing the burden of the disease and its diagnosis on patients with increasing utilization of surveillance and decreased employment of adjuvant therapy. For stage II disease, balancing the relative toxicities of radiation and chemotherapy while avoiding the use of multimodality therapy due to the additive long-term toxicity has become the priority.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.

    Article  PubMed  CAS  Google Scholar 

  2. Purdue MP, Devesa SS, Sigurdson AJ, McGlynn KA. International patterns and trends in testis cancer incidence. Int J Cancer. 2005;115(5):822–7.

    Article  PubMed  CAS  Google Scholar 

  3. Sokoloff MH, Joyce GF, Wise M. Urologic Diseases in America P. Testis cancer. J Urol. 2007;177(6):2030–41.

    Article  PubMed  Google Scholar 

  4. Shah M, Devessa S, Zhu K, McGlynn K. Trends in testicular germ cell tumours by ethnic group in the United States. Int J Androl. 2007;30(4):206–13.

    Article  PubMed  Google Scholar 

  5. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

    Article  PubMed  Google Scholar 

  6. Ruf CG, Isbarn H, Wagner W, Fisch M, Matthies C, Dieckmann KP. Changes in epidemiologic features of testicular germ cell cancer: age at diagnosis and relative frequency of seminoma are constantly and significantly increasing(). Urol Oncol 2013.

  7. Beyer J, Albers P, Altena R, et al. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol. 2013;24(4):878–88.

    Article  PubMed  CAS  Google Scholar 

  8. Chung P, Mayhew LA, Warde P, Winquist E, Lukka H. Genitourinary Cancer Disease Site Group of Cancer Care Ontario's Program in Evidence-based C. Management of stage I seminomatous testicular cancer: a systematic review. Clin Oncol (R Coll Radiol). 2010;22(1):6–16.

    Article  CAS  Google Scholar 

  9. Thong AE, Lichtensztajn DY, Almario L, Ingels A, Gomez SL, Gonzalgo ML. Stage I testicular seminoma: a SEER analysis of contemporary adjuvant radiotherapy trends. J Urol 2013.

  10. Vossen CY, Horwich A, Daugaard G, van Poppel H, Osanto S. Patterns of care in the management of seminoma stage I: results from a European survey. BJU Int. 2012;110(4):524–31.

    Article  PubMed  Google Scholar 

  11. Arvold ND, Catalano PJ, Sweeney CJ, et al. Barriers to the implementation of surveillance for stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2012;84(2):383–9.

    Article  PubMed  Google Scholar 

  12. Chung P, Warde P. Testicular cancer: seminoma. Clin Evid (Online) 2011;2011.

  13. Kamba T, Kamoto T, Okubo K, et al. Outcome of different post-orchiectomy management for stage I seminoma: Japanese multi-institutional study including 425 patients. Int J Urol. 2010;17(12):980–7.

    Article  PubMed  Google Scholar 

  14. Fossa S, Horwich A, Russell J, et al. Optimal planning target volume for stage I testicular seminoma: a Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. J Clin Oncol. 1999;17(4):1146–54.

    PubMed  CAS  Google Scholar 

  15. Logue J, Harris M, Livsey J, Swindell R, Mobarek N, Read G. Short course para-aortic radiation for stage I seminoma of the testis. Int J Radiat Oncol Biol Phys. 2003;57(5):1304–9.

    Article  PubMed  Google Scholar 

  16. Classen J, Schmidberger H, Meisner C, et al. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer. 2004;90(12):2305–11.

    PubMed  CAS  Google Scholar 

  17. Paly JJ, Efstathiou JA, Hedgire SS, et al. Mapping patterns of nodal metastases in seminoma: rethinking radiotherapy fields. Radiother Oncol. 2013;106(1):64–8.

    Article  PubMed  Google Scholar 

  18. Jones W, Fossa S, Mead G, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: A report on Medical Research Council Trial TE18, European Organization for the Research and Treatment of Cancer Trial 20942 (ISRCTN18525328). J Clin Oncol. 2005;23(6):1200–08.

    Article  PubMed  Google Scholar 

  19. • Mead G, Fossa S, Oliver R, et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. JNCI. 2011;103:241–9. This article summarizes the mature results of the only randomized controlled trials in stage I seminoma and demonstrate that para-aortic radiotherapy to a dose of 20 Gy or single cycle of carboplatin chemotherapy are both good options for adjuvant therapy.

    Article  PubMed  Google Scholar 

  20. Bieri S, Rouzaud M, Miralbell R. Seminoma of the testis: is scrotal shielding necessary when radiotherapy is limited to the para-aortic nodes? Radiother Oncol. 1999;50(3):349–53.

    Article  PubMed  CAS  Google Scholar 

  21. Jacobsen K, Olsen D, Fossa K, Fossa S. External beam abdominal radiotherapy in patients with seminoma stage I: field type, testicular dose, and spermatogenesis. Int J Radiat Oncol Biol Phys. 1997;38(1):95–102.

    Article  PubMed  CAS  Google Scholar 

  22. Haugnes HS, Wethal T, Aass N, et al. Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study. J Clin Oncol. 2010;28(30):4649–57.

    Article  PubMed  Google Scholar 

  23. Huddart RA, Norman A, Shahidi M, et al. Cardiovascular disease as a long-term complication of treatment for testicular cancer. J Clin Oncol. 2003;21(8):1513–23.

    Article  PubMed  CAS  Google Scholar 

  24. Zagars GK, Ballo MT, Lee AK, Strom SS. Mortality after cure of testicular seminoma. J Clin Oncol. 2004;22(4):640–7.

    Article  PubMed  Google Scholar 

  25. Haugnes H, Wethal T, Aass N, et al. Cardiovascular risk factors and morbidity in long-term survivors of testicular cancer: a 20-year follow-up study. JCO. 2010;29:4649–57.

    Article  Google Scholar 

  26. Beard CJ, Travis LB, Chen MH, et al. Outcomes in stage I testicular seminoma: a population-based study of 9193 patients. Cancer 2013.

  27. van den Belt-Dusebout AW, de Wit R, Gietema JA, et al. Treatment-specific risks of second malignancies and cardiovascular disease in 5-year survivors of testicular cancer. J Clin Oncol. 2007;25(28):4370–8.

    Article  PubMed  Google Scholar 

  28. Wethal T, Haugnes HS, Kjekshus J, et al. C-reactive protein; a potential marker of second cancer and cardiovascular disease in testicular cancer survivors? Eur J Cancer. 2010;46(18):3425–33.

    Article  PubMed  CAS  Google Scholar 

  29. Wethal T, Kjekshus J, Roislien J, et al. Treatment-related differences in cardiovascular risk factors in long-term survivors of testicular cancer. J Cancer Surviv. 2007;1(1):8–16.

    Article  PubMed  CAS  Google Scholar 

  30. Travis L, Fossa S, Schonfeld S, et al. Second cancers among 40576 testicular cancer patients: focus on long-term survivors. JNCI. 2005;97(18):1354–65.

    Article  PubMed  Google Scholar 

  31. Hemminki K, Liu H, Sundquist J. Second cancers after testicular cancer diagnosed after 1980 in Sweden. Ann Oncol. 2010;21(7):1546–51.

    Article  PubMed  CAS  Google Scholar 

  32. Efstathiou JA, Paly JJ, Lu HM, et al. Adjuvant radiation therapy for early stage seminoma: proton versus photon planning comparison and modeling of second cancer risk. Radiother Oncol. 2012;103(1):12–7.

    Article  PubMed  Google Scholar 

  33. Zwahlen DR, Martin JM, Millar JL, Schneider U. Effect of radiotherapy volume and dose on secondary cancer risk in stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2008;70(3):853–8.

    Article  PubMed  Google Scholar 

  34. Simone 2nd CB, Kramer K, O'Meara WP, et al. Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma. Int J Radiat Oncol Biol Phys. 2012;82(1):242–9.

    Article  PubMed  Google Scholar 

  35. Yoshida T, Kakimoto K, Takezawa K, et al. Surveillance following orchiectomy for stage I testicular seminoma: long-term outcome. Int J Urol. 2009;16(9):756–9.

    Article  PubMed  Google Scholar 

  36. Leung E, Warde P, Jewett M, et al. Treatment burden in stage I seminoma: a comparison of surveillance and adjuvant radiation therapy BJU Int 2013;in press.

  37. Daugaard G, Petersen P, Rorth M. Surveillance in stage I testicular cancer. APMIS. 2003;111(1):76–85.

    Article  PubMed  Google Scholar 

  38. Kamba T, Kamoto T, Okubo K, et al. Outcome of different post-orchiectomy management for stage I seminoma: Japanese multi-institutional study including 425 patients. Int J Urol. 2010;17:980–88.

    Article  PubMed  Google Scholar 

  39. Chung P, Parker C, Panzarella T, et al. Surveillance in stage I testicular seminoma - risk of late relapse. Can J Urol. 2002;9(5):1637–40.

    PubMed  CAS  Google Scholar 

  40. Aparicio J, Germa J, Del Muro X, et al. Risk-adapted management for patients with clinical stage I seminoma: the second Spanish Germ Cell Cancer Cooperative Group study. J Clin Oncol. 2005;23(34):8717–23.

    Article  PubMed  Google Scholar 

  41. Aparicio J, Maroto P, del Muro XG, et al. Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish Germ Cell Cancer Group study. J Clin Oncol. 2011;29(35):4677–81.

    Article  PubMed  Google Scholar 

  42. Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20(22):4448–52.

    Article  PubMed  Google Scholar 

  43. Cummins S, Yau T, Huddart R, Dearnaley D, Horwich A. Surveillance in stage I seminoma patients: a long-term assessment. Eur Urol. 2010;57(4):673–8.

    Article  PubMed  Google Scholar 

  44. Ruf CG, Linbecker M, Port M, et al. Predicting metastasized seminoma using gene expression. BJU Int. 2012;110(2 Pt 2):E14–20.

    Article  PubMed  CAS  Google Scholar 

  45. Ruf CG, Khalili-Harbi N, Sachs S, et al. The search for biomarkers of metastatic seminoma. J Urol 2013.

  46. Martin J, Panzarella T, Zwahlen D, Chung P, Warde P. Evidence-based guidelines for following stage I seminoma. Cancer Res. 2007;109(11):2248–56.

    Google Scholar 

  47. Marzani W, O'Malley M, Chung P, Warde P, Vesprini D, Panzarella T. Lymph node growth rate in testicular germ cell tumors: implications for computed tomography surveillance frequency. Clin Oncol 2010.

  48. Gilligan TD, Seidenfeld J, Basch EM, et al. American Society of Clinical Oncology Clinical Practice Guideline on uses of serum tumor markers in adult males with germ cell tumors. J Clin Oncol. 2010;28(20):3388–404.

    Article  PubMed  CAS  Google Scholar 

  49. Tolan S, Vesprini D, Jewett MA, et al. No role for routine chest radiography in stage I seminoma surveillance. Eur Urol. 2010;57(3):474–9.

    Article  PubMed  Google Scholar 

  50. Vesprini D, Chung P, Tolan S, et al. Utility of serum tumor markers during surveillance for stage I seminoma. Cancer. 2012;118(21):5245–50.

    Article  PubMed  CAS  Google Scholar 

  51. Mettler Jr FA, Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248(1):254–63.

    Article  PubMed  Google Scholar 

  52. Shrimpton PC, Hillier MC, Lewis MA, Dunn M. National survey of doses from CT in the UK: 2003. Br J Radiol. 2006;79(948):968–80.

    Article  PubMed  CAS  Google Scholar 

  53. Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004;363(9406):345–51.

    Article  PubMed  Google Scholar 

  54. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84.

    Article  PubMed  CAS  Google Scholar 

  55. van Walraven C, Fergusson D, Earle C, et al. Association of diagnostic radiation exposure and second abdominal-pelvic malignancies after testicular cancer. J Clin Oncol. 2011;29(21):2883–8.

    Article  PubMed  Google Scholar 

  56. Cafferty FH, Gabe R, Huddart RA, et al. UK management practices in stage I seminoma and the Medical Research Council Trial of Imaging and Schedule in Seminoma Testis managed with surveillance. Clin Oncol (R Coll Radiol). 2012;24(1):25–9.

    Article  CAS  Google Scholar 

  57. O'Malley M, Chung P, Haider M, et al. Comparison of low dose with standard dose abdominal/pelvic multidetector CT in patients with stage I testicular cancer under surveillance. Eur Radiol. 2010;20:1624–30.

    Article  PubMed  Google Scholar 

  58. Harisinghani MG, Saksena M, Ross RW, et al. A pilot study of lymphotrophic nanoparticle-enhanced magnetic resonance imaging technique in early stage testicular cancer: a new method for noninvasive lymph node evaluation. Urology. 2005;66(5):1066–71.

    Article  PubMed  Google Scholar 

  59. Oliver R, Mason M, Mead G, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366(9482):293–300.

    Article  PubMed  CAS  Google Scholar 

  60. • Oliver R, Mead G, Rustin G, et al. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: Mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). J Clin Oncol 2011. The updated results of the only randomized trial that compared the two forms of adjuvant treatment demonstrated noninferiority of carboplatin compared to radiotherapy.

  61. Oliver R, Mead G, Fogarty P, Stenning S. Radiotherapy versus carboplatin for stage I seminoma: updated analysis of the MRC/EORTC randomized trial (ISRCTN27163214). JCO. 2008;26:A1.

    Google Scholar 

  62. Powles T, Robinson D, Shamash J, Moller H, Tranter N, Oliver T. The long-term risks of adjuvant carboplatin treatment for stage I seminoma of the testis. Ann Oncol. 2008;19(3):443–7.

    Article  PubMed  CAS  Google Scholar 

  63. von der Maase H, Specht L, Jacobsen GK, et al. Surveillance following orchidectomy for stage I seminoma of the testis. Eur J Cancer. 1993;29A(14):1931–4.

    Article  PubMed  Google Scholar 

  64. Warde P, Huddart R, Bolton D, Heidenreich A, Gilligan T, Fossa S. Management of localized seminoma, stage I-II: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology. 2011;78(4 Suppl):S435–43.

    Article  PubMed  CAS  Google Scholar 

  65. Warde P, Gospodarowicz M, Panzarella T, et al. Stage I testicular seminoma: results of adjuvant radiation and surveillance. JCO. 1995;13:2255–62.

    CAS  Google Scholar 

  66. Chung PW, Bedard P. Stage II seminomas and nonseminomas. Hematol Oncol Clin North Am. 2011;25(3):529–41. viii.

    Article  PubMed  Google Scholar 

  67. Domont J, Massard C, Patrikidou A, et al. A risk-adapted strategy of radiotherapy or cisplatin-based chemotherapy in stage II seminoma. Urol Oncol 2011.

  68. Chung PW, Gospodarowicz MK, Panzarella T, et al. Stage II testicular seminoma: patterns of recurrence and outcome of treatment. Eur Urol. 2004;45(6):754–59. discussion 59-60.

    Article  PubMed  Google Scholar 

  69. Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003;21(6):1101–6.

    Article  PubMed  Google Scholar 

  70. Vallis KA, Howard GC, Duncan W, Cornbleet MA, Kerr GR. Radiotherapy for stages I and II testicular seminoma: results and morbidity in 238 patients. Br J Radiol. 1995;68(808):400–5.

    Article  PubMed  CAS  Google Scholar 

  71. Zagars GK, Pollack A. Radiotherapy for stage II testicular seminoma. Int J Radiat Oncol Biol Phys. 2001;51(3):643–9.

    Article  PubMed  CAS  Google Scholar 

  72. Tandstad T, Smaaland R, Solberg A, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish norwegian testicular cancer study group. J Clin Oncol. 2011;29(6):719–25.

    Article  PubMed  Google Scholar 

  73. Garcia-del-Muro X, Maroto P, Guma J, et al. Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study. J Clin Oncol. 2008;26(33):5416–21.

    Article  PubMed  CAS  Google Scholar 

  74. Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. 2011;22(4):808–14.

    Article  PubMed  CAS  Google Scholar 

  75. Patterson H, Norman AR, Mitra SS, et al. Combination carboplatin and radiotherapy in the management of stage II testicular seminoma: comparison with radiotherapy treatment alone. Radiother Oncol. 2001;59(1):5–11.

    Article  PubMed  CAS  Google Scholar 

  76. Horwich A, Dearnaley DP, Sohaib A, Pennert K, Huddart RA. Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann Oncol 2013.

  77. Herrera F, Berthold DR. Relapsed seminoma during surveillance: first treatment choice should be radiotherapy. J Clin Oncol. 2012;30(16):2021. author reply 22.

    Article  PubMed  Google Scholar 

  78. Krege S, Boergermann C, Baschek R, et al. Single agent carboplatin for CS IIA/B testicular seminoma. A phase II study of the German Testicular Cancer Study Group (GTCSG). Ann Oncol. 2006;17(2):276–80.

    Article  PubMed  CAS  Google Scholar 

  79. Mosharafa AA, Foster RS, Leibovich BC, Bihrle R, Johnson C, Donohue JP. Is post-chemotherapy resection of seminomatous elements associated with higher acute morbidity? J Urol. 2003;169(6):2126–8.

    Article  PubMed  Google Scholar 

  80. Becherer A, De Santis M, Karanikas G, et al. FDG PET is superior to CT in the prediction of viable tumour in post-chemotherapy seminoma residuals. Eur J Radiol. 2005;54(2):284–8.

    Article  PubMed  Google Scholar 

  81. Ganjoo KN, Chan RJ, Sharma M, Einhorn LH. Positron emission tomography scans in the evaluation of postchemotherapy residual masses in patients with seminoma. J Clin Oncol. 1999;17(11):3457–60.

    PubMed  CAS  Google Scholar 

  82. Hinz S, Schrader M, Kempkensteffen C, et al. The role of positron emission tomography in the evaluation of residual masses after chemotherapy for advanced stage seminoma. J Urol. 2008;179(3):936–40. discussion 40.

    Article  PubMed  Google Scholar 

  83. Herr HW, Sheinfeld J, Puc HS, et al. Surgery for a post-chemotherapy residual mass in seminoma. J Urol. 1997;157(3):860–2.

    Article  PubMed  CAS  Google Scholar 

  84. Culine S, Droz JP. Optimal management of residual mass after chemotherapy in advanced seminoma: there is time for everything. J Clin Oncol. 1996;14(10):2884–5.

    PubMed  CAS  Google Scholar 

  85. Duchesne GM, Stenning SP, Aass N, et al. Radiotherapy after chemotherapy for metastatic seminoma–a diminishing role. MRC Testicular Tumour Working Party. Eur J Cancer. 1997;33(6):829–35.

    Article  PubMed  CAS  Google Scholar 

  86. Choo R, Quevedo F, Choo CS, Blute M. Can radiotherapy be a viable salvage treatment option for the relapsed seminoma confined to the infra-diaphragm region recurring after primary chemotherapy for bulky stage II seminoma? Can Urol Assoc J. 2010;4(5):E137–40.

    PubMed  Google Scholar 

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Conflict of Interest

Dr. Peter Chung and Dr. Padraig Warde reported no potential conflicts of interest relevant to this article.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

Summary

Stage I seminoma is preferentially managed with surveillance and this approach allows the vast majority of patients to avoid further treatments and their associated toxicities after orchiectomy. Low volume stage II disease is adequately treated with RT alone. Balancing the relative risks of recurrence and the potential acute and long-term toxicities of various treatment modalities requires clinician and patient participation in decision-making that hopefully goes some way to allow for individualization of the management of the disease.

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  1. Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, Ontario, M5G 2M9, Canada

    Peter Chung & Padraig Warde

  2. Department of Radiation Oncology, University of Toronto, Toronto, Ontario, M5G 2M9, Canada

    Padraig Warde

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  1. Peter Chung
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Correspondence to Padraig Warde.

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Chung, P., Warde, P. Contemporary Management of Stage I and II Seminoma. Curr Urol Rep 14, 525–533 (2013). https://doi.org/10.1007/s11934-013-0365-2

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