Advanced seminoma: the role of chemotherapy and adjunctive surgery.
OBJECTIVE
To determine the effectiveness of chemotherapy and adjunctive surgery in managing patients with advanced seminoma.


METHODS
Nonrandomized prospective clinical trial of chemotherapy in a cohort of patients with advanced seminoma.


METHODS
Referral cancer hospital.


METHODS
Consecutive sample of 62 patients with primary extragonadal, stage IIC (greater than 5-cm retroperitoneal adenopathy) and stage III seminoma; 45 patients were previously untreated, 13 had received radiotherapy, and 4 had previously received radiotherapy and chemotherapy.


METHODS
Cisplatin-based chemotherapy (100 to 120 mg/m2 body surface area per cycle of treatment); 45 patients received vinblastine, bleomycin, cisplatin, dactinomycin, and cyclophosphamide; 15, etoposide and cisplatin; and 2, both regimens.


RESULTS
Fifty-three of the sixty (88%) evaluable patients achieved a complete remission, and only 6 patients had relapses. Fifty-three of the sixty-two patients (85%) remain alive and disease-free. The regimen of etoposide and cisplatin was equivalent to regimens using more drugs. An elevated level of human chorionic gonadotropin at the initiation of treatment was associated with a worse prognosis.


CONCLUSIONS
Cisplatin-based chemotherapy is effective treatment for patients with extragonadal, stage IIC, and stage III seminoma and should be considered as initial therapy.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000627:therapeutic use; D002699:Chlorambucil / Q000627:therapeutic use; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003609:Dactinomycin / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004407:Dysgerminoma / Q000188:drug therapy* / Q000601:surgery; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000188:drug therapy; D011446:Prospective Studies; D012074:Remission Induction; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy; D013736:Testicular Neoplasms / Q000188:drug therapy; D014747:Vinblastine / Q000627:therapeutic use
D001761:Bleomycin; D002699:Chlorambucil; D003609:Dactinomycin; D014747:Vinblastine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin