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]
Overview
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).The treatment options for recurrent seminoma include:[1]
- Standard-dose chemotherapy
- High-dose chemotherapy and stem cell transplant
- Palliative chemotherapy
Chemotherapy
- Chemotherapy is the mainstay of treatment for recurrent seminoma. The combination of chemotherapy drugs given will depend on the treatments used to treat the original cancer.[1]
Standard-Dose Chemotherapy
- Patients who were given radiation therapy after surgery to treat the primary cancer will be offered BEP for a recurrent seminoma. 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.[1]
- Patients who were given BEP or EP (etoposide and cisplatin) to treat the primary cancer may be given one of the following drug combinations as salvage, or second-line, chemotherapy. The combination is given intravenously for 5 days, every 3 weeks, for 3 months.[1]
- VIP is etoposide, ifosfamide (Ifex), and cisplatin.
- VeIP is vinblastine (Velbe), ifosfamide, and cisplatin.
- TIP is paclitaxel (Taxol), ifosfamide, and cisplatin.
High-Dose Chemotherapy and Stem Cell Transplant
- High-dose chemotherapy with carboplatin (Paraplatin, Paraplatin AQ) and etoposide may be indicated, if seminoma recurs after it is treated with standard-dose chemotherapy.[1]
- 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 uses stem cells from your own blood (called autologous peripheral blood stem cell transplant).[1]
Palliative Chemotherapy
- Chemotherapy can be used as palliative therapy for those patients who have recurrences after most other treatments. Palliative chemotherapy that may be used for recurrent seminoma includes:[1]
- Etoposide given orally
- Gemcitabine (Gemzar) with oxaliplatin (Eloxatin) OR paclitaxel given intravenously once every 4 weeks for 2–6 cycles
Surgery
- Surgery may be indicated if seminoma recurs more than 2 years after the primary cancer was treated.[1]
Radiation Therapy
- External beam radiation therapy for recurrent seminoma may be used if the cancer recurs during active surveillance or after chemotherapy with carboplatin.[1]
- The recurrence must only be in the retroperitoneal lymph nodes. Radiation is directed at the retroperitoneal lymph nodes.[1]