학술논문
Therapy of clinical stage IIA and IIB seminoma: a systematic review.
Document Type
Article
Author
Heinzelbecker, Julia; Schmidt, Stefanie; Lackner, Julia; Busch, Jonas; Bokemeyer, Carsten; Classen, Johannes; Dieing, Annette; Hakenberg, Oliver; Krege, Susanne; Papachristofilou, Alexandros; Pfister, David; Ruf, Christian; Schmelz, Hans; Schmidberger, Heinz; Souchon, Rainer; Winter, Christian; Zengerling, Friedemann; Kliesch, Sabine; Albers, Peter; Oing, Christoph
Source
Subject
*SEMINOMA
*LYMPHADENECTOMY
*SURVIVAL rate
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Language
ISSN
0724-4983
Abstract
Purpose: The optimal treatment for clinical stage (CS) IIA/IIB seminomas is still controversial. We evaluated current treatment options. Methods: A systematic review was performed. Only randomized clinical trials and comparative studies published from January 2010 until February 2021 were included. Search items included: seminoma, CS IIA, CS IIB and therapy. Outcome parameters were relapse rate (RR), relapse-free (RFS), overall and cancer-specific survival (OS, CSS). Additionally, acute and long-term side effects including secondary malignancies (SMs) were analyzed. Results: Seven comparative studies (one prospective and six retrospective) were identified with a total of 5049 patients (CS IIA: 2840, CS IIB: 2209). The applied treatment modalities were radiotherapy (RT) (n = 3049; CS IIA: 1888, CSIIB: 1006, unknown: 155) and chemotherapy (CT) or no RT (n = 2000; CS IIA: 797, CS IIB: 1074, unknown: 129). In CS IIA, RRs ranged from 0% to 4.8% for RT and 0% for CT. Concerning CS IIB RRs of 9.5%–21.1% for RT and of 0%–14.2% for CT have been reported. 5-year OS ranged from 90 to 100%. Only two studies reported on treatment-related toxicities. Conclusions: RT and CT are the most commonly applied treatments in CS IIA/B seminoma. In CS IIA seminomas, RRs after RT and CT are similar. However, in CS IIB, CT seems to be more effective. Survival rates of CS IIA/B seminomas are excellent. Consequently, long-term toxicities and SMs are important survivorship issues. Alternative treatment approaches, e.g., retroperitoneal lymph node dissection (RPLND) or dose-reduced sequential CT/RT are currently under prospective investigation. [ABSTRACT FROM AUTHOR]