699P - Prospective COTRIMS (COlogne Trial of Retroperitoneal Lymphadectomy in Metastastic Seminoma) trial: Three year update

Background

Radiation or chemotherapy represent the standard treatment in clinical stage IIA/B seminoma. Despite high cure rates both modalities are associated with significant long-term toxicities. The COTRIMS trial evaluated the oncological and functional efficicacy of primary retroperitoneal lymphadenectomy (RPLND) without adjuvant chemotherapy in CS IIA/B seminomas.

Methods

34 patients with CS IIA/B pure semimomas were prospectively recruited. Exclusion criteria were adjuvant chemotherapy following orchiectomy, CS IIC, previous retroperitoneal surgery or radiation, positive tumor markers. All patients underwent nerve sparing RPLND with a unilateral template; no adjuvant chemotherapy was delivered. Follow-up was done according to EAU guidelines. In 22 patients mir371 was evaluated preoperatively and correlated with pathohistology of lymph nodes.

Results

Median age is 34.2 (21-54) years, mean and median follow-up is 41.5 (4-73) and 33.4 (13-56) months. 22 and 12 pts had CS IIA and CS IIB, resp. Mean OR-time, blood loss and hospitalisation were 131 (105-195) min, < 150ml and 4 (3-9) days. 4 (11.7%) pts experienced Clavien Dindo 3a complication. Antegrade ejaculation was preserved in 88%. A mean of 19 (7-57) lymph nodes were dissected. Mean number of positive lymph nodes was 1.4 (1-2), mean diameter was 2.3 (0.8-4.1) cm. Seminoma was present in 85%, non-malignancy and nonseminoma were found in 8.9% and 5.9%. miR371 was positive in 17/18 pts with metastases und negative in 3/3 with benign lesions. 4 (11.7%) pts relapsed after 4, 6, 9 and 12 months and all were salvaged by chemotherapy.

Conclusions

RPLND results in high cure rates associated with low frequency of surgery – related complication even after a follow-up of about 3 years. Nearly 90% of patients can be managed without systemic chemotherapy. RPLNSD should be included in the treatment options for CS IIA/B seminomas. miR371 appears to be a valid biomarker to predict presence of lymph node metastases.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Axel Heidenreich.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.