Seminoma medical therapy treatment - recurrent

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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]

Medical Therapy

Treatment options for recurrent seminoma depend on the treatments used for the original tumor, recurrence rate, and the prognosis group (which is based on the International Germ Cell Cancer Consensus Group (IGCCCG) classification system).

Read more: http://www.cancer.ca/en/cancer-information/cancer-type/testicular/treatment/seminoma/recurrent/?region=on#ixzz41luGvCFX

• In case of seminoma, the healthcare team creates an individualized treatment plan. It is generally based on the patient's needs and may include a combination of different treatments. The factors which help in deciding the treatment plan for seminoma include:

• Stage of seminoma
• Risk of recurrence
• Fertility
• Preferences of the individual

• The various treatment options depending on the stage and recurrence risk of seminoma are discussed below.

Treatment of Seminoma

Stage I

Stage II

Stage III

Recurrent

❑ Surgery ❑ Active surveillance ❑ Radiotherapy ❑ Chemotherapy

❑ Surgery ❑ Radiotherapy ❑ Chemotherapy

❑ Surgery ❑ Chemotherapy

❑ Chemotherapy ❑ Stem Cell Transplantation ❑ Surgery

Chemotherapy

• Chemotherapy is a common treatment for all stages of seminoma. It is usually given after an orchiectomy. A combination of chemotherapy drugs is usually given.
• BEP is the main chemotherapy combination used for seminoma. It includes bleomycin, etoposide, and cisplatin.
• Sometimes, physicians just give etoposide and cisplatin (called EP). EP is given when bleomycin affects the lungs (called pulmonary toxicity), or there is a high risk that it will cause lung damage.
• High-dose chemotherapy and stem cell transplant may be used for recurrent testicular cancer, if the standard-dose chemotherapy doesn’t work and the cancer comes back.
• High doses of carboplatin and etoposide are given. After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that are damaged or destroyed by high-dose chemotherapy. The stem cell transplant is an autologous peripheral blood stem cell transplant.

Radiotherapy

• Radiation therapy may be used to treat stage I or II seminomas after orchiectomy.
• It is given as external beam radiation therapy.
• Radiation is directed at the lymph nodes in the abdomen and pelvis.

Active Surveillance

• Active surveillance is the preferred treatment for stage I seminoma after a radical inguinal orchiectomy.
• During active surveillance, the healthcare team watches for any signs and symptoms of recurrence. Treatment is given only if seminoma recurs.