RPLND for Early Metastatic Seminoma Offers Low Long-term Morbidity

By Emily Menendez - Last Updated: June 26, 2023

Retroperitoneal lymph node dissection (RPLND) is an established treatment for patients with testicular germ cell tumors with minimal late morbidity. As the toxicities of chemotherapy and radiotherapy can negatively impact the quality of life of testicular cancer survivors, RPLND offers less burden to patients. However, little is known about the use and efficacy of RPLND in early metastatic seminoma.

A prospective, phase 2, single-arm, multi-institutional trial led by Siamak Daneshmand, MD, aims to examine the efficacy of surgery in early metastatic seminoma by utilizing RPLND as a first-line treatment for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy.

A total of 55 adult patients with testicular seminoma and isolated retroperitoneal lymphadenopathy (1-3 cm) were prospectively enrolled across 12 sites in the United States and Canada. Surgeons performed open RPLND on patients and assessed complication rates, recurrence patterns, pathologic up/downstaging, adjuvant therapies, and treatment-free survival.

The median largest clinical lymph node size was 1.6 cm (range, 1.3-1.9 cm), while RPLND pathology reported a median largest lymph node size of 2.3 cm (range, 0.9-3.5 cm). One patient received adjuvant chemotherapy. A total of 9 patients (16%) were pN0, 12 (22%) were pN1, 31 (56%) were pN2, and 3 (5%) were pN3.

The study’s primary end point was 2-year recurrence-free survival (RFS). With a median follow-up of 33 months (range, 12.0-61.6 months), 12 patients experienced recurrence, with 10 patients undergoing chemotherapy and 2 receiving additional surgery. The 2-year RFS rate was 81%, and the recurrence rate was 22%.

At the final follow-up, all patients who experienced recurrence were disease-free, and the 2-year overall survival rate was 100%. Short-term complications were noted in 4 patients (7%), and another 4 patients experienced long-term complications, including incisional hernia (1) and anejaculation (3).

This prospective trial demonstrates the effectiveness of RPLND as a treatment option for testicular seminoma with clinically low-volume retroperitoneal lymphadenopathy that offers low long-term morbidity.