Open Access

REVIEW

Treatment options in stage I seminoma

UROS BUMBASIREVIC^1,2,*, MARKO ZIVKOVIC¹, MILOS PETROVIC¹, VESNA CORIC^2,3, NIKOLA LISICIC¹, NEBOJSA BOJANIC^1,2

1 Clinic of Urology, University Clinical Center of Serbia, Belgrade, 11000, Serbia
2 Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
3 Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia

* Corresponding Author: UROS BUMBASIREVIC. Email:

Oncology Research 2022, 30(3), 117-128. https://doi.org/10.32604/or.2022.027511

Received 02 November 2022; Accepted 03 January 2013; Issue published 12 January 2023

Abstract

Seminomas are most commonly diagnosed in clinical stage I (CSI). After orchiectomy, approximately 15% of patients in this stage have subclinical metastases. Adjuvant radiotherapy (ART) delivered to the retroperitoneum and ipsilateral pelvic lymph nodes has been the mainstay of treatment for many years. Although highly efficient, with long-term cancer-specific survival (CSS) rates approaching almost 100%, ART is associated with considerable long-term consequences, particularly cardiovascular toxicity and increased risk of secondary malignancies (SMN). Therefore, active surveillance (AS) and adjuvant chemotherapy (ACT) were developed as alternative treatment options. While AS prevents patient overtreatment, it is associated with strict follow-up regimens and increased radiation exposure due to repeated imaging. Due to equivalent CSS rates to ART, and lower toxicity, one course of adjuvant carboplatin presents the cornerstone of chemotherapy for CSI patients. CSS is almost 100% for patients with CSI seminoma, regardless of the chosen treatment option. Therefore, a personalized approach in treatment selection is preferred. Currently, routine radiotherapy for CSI seminoma patients is no longer recommended. Instead, it should be reserved for patients who are unfit or unwilling for AS or ACT. Identification of prognostic factors for disease relapse allowed for the development of risk-adapted treatment strategy and stratification of patients in low-risk and high-risk groups. Although risk-adapted policy needs further validation, surveillance is currently recommended in low-risk patients, while ACT is reserved for patients with a higher risk of relapse.

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Keywords

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