title: Advanced seminoma: the role of chemotherapy and adjunctive surgery.
abstract: 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.
mesh_terms: 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
chemical_list: D001761:Bleomycin; D002699:Chlorambucil; D003609:Dactinomycin; D014747:Vinblastine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin