[Therapeutical options for seminomas at clinical stage I-IIA/B].
Seminomas represent the most common histological subgroup of all testicular germ cell tumors. About 75% of all seminomas present as clinical stage I disease at time of initial diagnosis and exhibit a long-term cure rate of 99%. Management strategies maintaining these high cure rates but minimizing the risks need are actively pursued. Currently, three treatment strategies are available for stage I seminomas: surveillance, radiotherapy and chemotherapy. Pathohistological prognostic factors allow an individualized risk-adapted therapeutic approach. Tumor size < or =4 cm and absence of rete testis invasion define a low-risk group with a recurrence rate of 12% being best managed by surveillance. Tumor size >4 cm and presence of rete testis invasion define a high-risk with a 35% risk of relapse, best managed by active therapy. Active treatment either consists of radiation of the ipsilateral paracaval or paraaortic lymph nodes with 20 Gy or of adjuvant chemotherapy with 2 cycles of carboplatin. It is currently unclear if 1 cycle carboplatin is as effective as 2 cycles; if this approach is performed follow-up has to be standardized and a compliance of both patient and physician are mandatory.
Heidenreich
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Sektion für Urologische Onkologie, Klinik und Poliklinik für Urologie, Universität zu Köln. axel.heidenreich@uk-koeln.de
D000970:Antineoplastic Agents / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use*; D005858:Germany; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D016190:Carboplatin