Is Surgery the Right Approach for Primary RPLND for Stage II Seminoma?

By Emily Menendez - February 27, 2023

Clinical stage (CS) II seminoma is commonly treated with radiotherapy or chemotherapy based on guidelines from the National Comprehensive Cancer Network. Primary retroperitoneal lymph node dissection (RPLND) has recently demonstrated success as another first-line therapy option for retroperitoneal (RP)-only disease.

Tachibana et al conducted a study to determine the surgical efficacy of RPLND and to evaluate recurrence after primary RPLND for CS IIA/IIB seminoma to determine if certain clinical factors could predict disease recurrences.

They formed a study group of 67 patients who underwent primary RPLND for RP-only seminoma between 2014 and 2021. Each patient had at least 6 months of follow-up, and 19 patients were part of a clinical trial. One patient had pN0 disease. The median follow-up time after RPLND was 22.4 months (interquartile range, 12.3-36.1 months), and 11 patients were found to have a recurrence.

The 2-year recurrence-free survival (RFS) for RPLND-only patients without adjuvant chemotherapy was 80.2%. Patients who developed RP disease for more than 12 months had the lowest chance of recurrence, with a 2-year RFS of 92.2%. A total of 7 initial CS II patients were on surveillance for 3 to 12 months before surgery, and no patients experienced recurrence. Pathologic nodal stage and high-risk factors such as a tumor size greater than 4 cm or rete testis invasion of the orchiectomy specimen did not affect recurrence in patients.

CS II seminoma can be treated with surgery to avoid the potential harmful side effects of chemotherapy or radiotherapy. The study found that patients with a delayed development of CS II disease (more than 12 months) had the best surgical results. If a patient presents with borderline CS II disease, careful surveillance may avoid overtreatment; however, further research is needed on patient selection and extent of dissection, which remains uncertain.