Cisplatin-based chemotherapy for advanced seminoma: report of 52 cases treated in two institutions

J Cancer Res Clin Oncol. 2009 Nov;135(11):1495-500. doi: 10.1007/s00432-009-0596-2. Epub 2009 May 13.

Abstract

Introduction: We evaluated an intensified therapeutic strategy in order to optimize treatment outcomes while maintaining acceptable toxicity in patients with advanced seminoma.

Patients and methods: Fifty-two patients with advanced pure seminoma were retrospectively evaluated. Patients with low-risk advanced seminoma, according to the International Germ Cell Cancer Collaborative Group Consensus Classification criteria, had received four cycles of the BEP regimen either in the 5-day or the alternative 3-day schedule, while patients with intermediate-risk advanced seminoma had received four cycles of the IBEP regimen.

Results: Forty-two patients (80.7%) had testicular seminoma while ten patients (19.3%) presented with primary extragonadal (mediastinal or retroperitoneal) tumor. Forty-seven (90.8%) patients belonged to the low-risk group and five patients (9.2%) to the intermediate-risk group. Treatment-related toxicity was moderate, with febrile neutropenia being the most prevalent (13.5%). Twenty patients (38.5%) achieved a complete response to chemotherapy. Twenty-three from the remaining 32 patients had residual masses more than 3 cm and were submitted to surgery (2 patients), FDG-PET scan (8 patients) or surveillance (13 patients). After 69 months of follow-up there were three recurrences that were successfully treated with high-dose or salvage chemotherapy. No death by any cause was recorded.

Conclusions: Intensified cisplatin-based chemotherapy for patients with advanced seminoma does not confer evidence of superiority over radiotherapy alone or the standard BEP regimen. Patients with low-volume abdominal disease (clinical stage IIA and IIB) can be cured by four cycles of BEP instead of radiotherapy at the cost of a substantial increase in chemotherapy exposure and the resulting toxicity.

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bleomycin / therapeutic use
  • Cisplatin / administration & dosage*
  • Cisplatin / adverse effects
  • Cisplatin / therapeutic use
  • Etoposide / therapeutic use
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Retrospective Studies
  • Seminoma / drug therapy*
  • Seminoma / mortality
  • Seminoma / pathology
  • Testicular Neoplasms / drug therapy*
  • Testicular Neoplasms / mortality
  • Testicular Neoplasms / pathology

Substances

  • Bleomycin
  • Etoposide
  • Cisplatin

Supplementary concepts

  • BEP protocol