Seminoma medical therapy treatment - stage III
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Surgery is a primary treatment for stage III seminoma. Chemotherapy is usually given after surgery.[1]
Medical Therapy
The treatment options for stage III seminoma include:[1]
Surgery
- Surgery is a primary treatment for stage III seminoma. Radical inguinal orchiectomy is the preferred surgery. This surgery removes the testicle and spermatic cord through a small opening in the groin. It’s usually done as part of diagnosis.[1]
- In some cases, chemotherapy is given before an orchiectomy, when cancer has spread over a large area of the abdomen.
- After orchiectomy, chemotherapy is usually given. After chemotherapy, the healthcare team will follow up with imaging tests to look for any residual disease and signs that the cancer has recurred. It is common for imaging tests to find a mass in the abdomen after chemotherapy. This mass may not be cancer. If the mass is smaller than 3 cm in diameter, the man will be placed under observation and will continue to have regular imaging tests. If the mass is bigger than 3 cm in diameter, a PET scan is usually done about 2 months after chemotherapy to check the mass for cancer. If the PET scan shows the mass is cancer, surgical resection may be done to remove the mass. This surgery is sometimes called salvage surgery. Once the mass is removed, a biopsy may be done to confirm that it is cancer.
- Salvage surgery may include a bilateral retroperitoneal lymph node dissection (RPLND). This surgery removes retroperitoneal lymph nodes on both sides of the body. Decision to do an RPLND is based on imaging tests, biopsy of a mass, or an increase in serum tumor marker levels.[1]
Chemotherapy
- Chemotherapy is a standard treatment for stage III seminoma. It is usually given after radical inguinal orchiectomy. Chemotherapy may also be used before surgery if the cancer had already spread and doctors confirmed it was seminoma by doing a biopsy of the metastasis.[1]
- BEP is bleomycin (Blenoxane), etoposide (Vepesid, VP-16), and cisplatin (Platinol AQ). It is given intravenously for 5 days, every 3 weeks, for 2–3 months.
- EP is etoposide and cisplatin. EP may be used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage. It is given intravenously for 5 days, every 3 weeks, for 3 months.
- VIP is etoposide, ifosfamide (Ifex), and cisplatin. VIP may be used when bleomycin affects the lungs (called pulmonary toxicity) or there is a high risk that it will cause lung damage. It is given intravenously for 5 days, every 3 weeks, for 3 months.[1]
- The combination of chemotherapy drugs used depends on the tumor’s prognosis, which is based on the International Germ Cell Cancer Consensus Group (IGCCCG) classification system.[1]
- Men who have tumors in the good prognosis group are offered BEP or EP.
- Men who have tumors in the intermediate prognosis group are offered BEP or VIP.
- After chemotherapy, the healthcare team will follow up to look for any residual disease and signs that the cancer has recurred.
- If there is residual disease after chemotherapy, the healthcare team will decide on treatments based on the size of the mass. If the mass is smaller than 3 cm in diameter and it isn’t growing, active surveillance is offered. If the mass is bigger than 3 cm in diameter, a PET scan is usually done about 2 months after chemotherapy to check if it is cancer. If the mass is found out to be cancerous based on the PET scan but is not resectable, other chemotherapy combinations may be given.[1]