Introduction: Retroperitoneal radiation therapy or systemic chemotherapy with 3 cycles PEB represent the guideline recommended treatment options in marker negative clinical stage IIA/B seminoma. Despite a high cure rate of 90% to 94% and 82% to 90% in CS IIA and IIB, respectively, both therapeutic options are associated with significant long-term toxicities. It was the aim of our trial to evaluate the feasibility, oncological efficacy and treatment associated morbidity of primary nsRPLND in stage IIA/B seminoma
Methods: 16 patients with marker negative clinical stage IIA and IIB classical seminoma of the testis were recruited in the prospective trial. Exclusion criteria were adjuvant carboplatin therapy for clinical stage I disease, extensive clinical stage IIb or clinical stage IIc, previous retroperitoneal surgery or radiation therapy, positive tumor markers
Results: Mean age was 37.2 (21-54) years. Mean follow-up is 21.2 (1-36) months. All patients were treatment-naïve and 9 and 7 patients were diagnosed with stage IIA/B at time of primary diagnosis or during active surveillance for clinical stage I disease, respectively. 13 and 3 patients were diagnosed with stage IIA and IIB disease, respectively. 14 and 2 patients underwent open and robot assisted ns RPLND, respectively. Mean OR time was 131 (105-195) min, mean blood loss was < 150ml and the mean hospitalization time was 4.5 (3-9) days. We did not observe surgery associated complications > Clavien Dindo grade 3a. Histology of the resected lymph nodes revealed metastatic seminoma in 12 (75%) patients; 1 and 3 patients demonstrated embryonal carcinoma and inflammatory disease, respectively. 2/16 (12.5%) patients developed an outfield relapse 4 and 6 months postoperatively. Both patients were salvaged by systemic chemotherapy with 4 cycles PEB.
Conclusions: NsRPLND results in a high cure rate at midterm follow-up and it is associated with a low frequency of treatment associated morbidities making this approach a feasible alternative to standard radiation therapy or systemic chemotherapy.
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