Abstract 514P
Background
Retroperitoneal radiation therapy or systemic chemotherapy with 3 cycles PEB represent the guideline recommended treatment options in marker negative clinical stage IIA/B seminoma. Despite a high cure rate of 90% to 94% and 82% to 90% in CS IIA and IIB, respectively, both therapeutic options are associated with significant long-term toxicities. It was the aim of our trial to evaluate the feasibility, oncological efficacy and treatment associated morbidity of primary nsRPLND in stage IIA/B seminoma.
Methods
21 patients with marker negative clinical stage IIA and IIB classical seminoma of the testis were recruited in the prospective trial. Exclusion criteria were adjuvant carboplatin therapy for clinical stage I disease, extensive clinical stage IIb or clinical stage IIc, previous retroperitoneal surgery or radiation therapy, positive tumor markers.
Results
Mean age was 37.8 (21-54) years. Mean follow-up is 20.1 (1-48) months and 26 (3-48) for those with a minimum follow-up of 3 months. All patients were treatment-naïve; 9 and 12 patients presented in stage IIA/B at time of primary diagnosis or during active surveillance for clinical stage I disease, respectively. 13 and 8 patients were diagnosed with stage IIA and IIB disease, respectively. 19 and 2 patients underwent open and robot assisted ns RPLND, respectively. Mean OR time was 131 (105-195) min, mean blood loss was < 150ml and the mean hospitalization time was 4.5 (3-9) days. We did not observe surgery associated complications > Clavien Dindo grade 3a. Mean number of dissected lymph nodes was 17 (7-57), the mean number of positive lymph nodes was 1 (1-2) and the mean diameter of positive nodes was 2.1 (0.8-4.1) cm. Histology of the resected lymph nodes revealed metastatic seminoma in 17 (80.9%) patients; 1 and 3 patients demonstrated embryonal carcinoma and benign disease, resp. 2/21 (9.5%) patients developed an outfield relapse 4 and 6 months postoperatively. Both patients were salvaged by systemic chemotherapy with 4 cycles PEB.
Conclusions
NsRPLND results in a high cure rate at midterm follow-up and it is associated with a low frequency of treatment associated morbidities making this approach a feasible alternative to standard radiation therapy or systemic chemotherapy.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Axel Heidenreich.
Funding
Has not received any funding.
Disclosure
A. Heidenreich: Financial Interests, Personal, Invited Speaker: Astellas, Janssen, BMS, Pfizer, BMS; Financial Interests, Personal, Advisory Board: Bayer, AstraZeneca, MSD, Clovis. All other authors have declared no conflicts of interest.