Retroperitoneal Lymph Node Dissection for Testicular Seminoma: A Phase 2 Trial

By Emily Menendez - March 30, 2023

Retroperitoneal lymph node dissection (RPLND) is a well-established treatment for patients with testicular germ cell tumors with minimal late morbidity, yet little data is available on the treatment’s efficacy for early metastatic seminoma. A breakdown of a prospective, phase 2, single-arm, multi-institutional trial of RPLND as first-line treatment for early metastatic testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy was published in the Journal of Clinical Oncology.

A total of 12 sites throughout the United States and Canada participated in the trial, enrolling 55 adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy. The median largest clinical lymph node size was 1.6 cm (1.3-1.9 cm), and RPLND pathology demonstrated a median largest lymph node size of 2.3 cm (0.9-3.5 cm). Nine patients (16%) were pN0, 12 patients (22%) were pN1, 31 patients (56%) were pN2, and 3 patients (5%) were pN3.

Open RPLND was performed, with a primary end point of 2-year recurrence-free survival (RFS). Complication rates, pathologic up/downstaging, recurrence patterns, adjuvant therapies, and treatment-free survival were assessed. Recurrence occurred in 12 patients, with a 2-year RFS of 81% and a recurrence rate of 22%. Of these 12 patients, 10 received chemotherapy and 2 received additional surgery.

At final follow-up, all patients who had recurrence were disease-free, with a 100% 2-year overall survival rate. Four patients (7%) had short-term complications, and an additional 4 patients experienced long-term complications, including incisional hernia (1 patient) and anejaculation (3 patients).

Overall, RPLND has been demonstrated to be a viable treatment option for patients with testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy, and it is associated with low rates of long-term morbidity.