Thomas L. Jang
SAN FRANCISCO — Retroperitoneal lymph node dissection conferred favorable survival rates among men with testicular seminoma used as first-line therapy or following chemotherapy, according to study results presented at Genitourinary Cancers Symposium.
“Although retroperitoneal lymph node dissection is rarely used as primary therapy in these men, overall survival rates appear to be favorable,” Thomas L. Jang, MD, MPH, FACS, urologic oncologist and assistant professor of surgery at Rutgers Robert Wood Johnson Medical School, said in a press release. “Our findings are directional and ultimately, ongoing prospective trials, such as the SEMS (Surgery in Early Metastatic Seminoma) trial, will clarify the role of surgery in this setting.”
The use of retroperitoneal lymph node dissection as first-line therapy for testicular seminoma is not as well defined as it is for nonseminomas.
Also, it can be challenging to perform retroperitoneal lymph node dissection following chemotherapy for patients with PET avid residual masses larger than 3 cm.
Jang and colleagues used 2004 to 2014 data from the National Cancer Database to evaluate the use of retroperitoneal lymph node dissection in the primary and post-chemotherapy settings and its impact on OS.
Researchers identified 62,727 men with primary testicular cancer, 31,068 of whom had seminoma.
After excluding men with benign, nongerm cell and nonseminoma histologies; those who did not undergo retroperitoneal lymph node dissection; and those without clinical stage or survival data, the final cohort included 412 men.
Eighty-nine percent of the cohort (n = 365; median age, 40 years; range 0-81) underwent retroperitoneal lymph node dissection in the first-line setting and the other 11% did so following chemotherapy. Researchers did not observe major differences between these two groups.
Most men undergoing retroperitoneal lymph node dissection after chemotherapy were treated at an academic medial center (63.8%) or a comprehensive community cancer program (21.3%).
Median follow-up was 4.1 years.
Researchers reported 5-year OS rates of 94.2% for those receiving first-line retroperitoneal lymph node dissection, and 89% for those receiving retroperitoneal lymph node dissection following chemotherapy.
“Although retroperitoneal lymph node dissection is rarely used as first-line therapy in testicular seminoma, overall survival rates appear to be excellent, as they do for men with testicular seminoma after post-chemotherapy retroperitoneal lymph node dissection,” the researchers wrote. “Ongoing trials evaluating the use of retroperitoneal lymph node dissection for early metastatic, low-volume disease will clarify its role in the management of testicular seminoma.” – by Alexandra Todak
Tabakin A, et al. Abstract 534. Presented at: Genitourinary Cancers Symposium; Feb. 14-16, 2019; San Francisco.
Disclosures: One author reports research funding from Astellas/Medivation. Jang and the other authors report no relevant financial disclosures.