Testicular cancer is the most commonly-diagnosed malignancy in men in the US between the ages of 20 and 45 years. Eighty percent of testicular seminoma patients present with stage I disease and 11% present with stage II disease. Prior studies of stage IIA and IIB testicular seminoma typically involved fewer than 130 patients. By using the Surveillance, Epidemiology and End Results (SEER) database between the years of 1988 and 2003, Ahmed and Wilder were able to study 241 stage IIA and IIB patients with a median follow up of 10 years. Their study of stage IIA and IIB testicular seminoma is the largest one in the literature. However, one limitation of the SEER database is a lack of randomization with regards to treatment. Other limitations include a lack of treatment details such as chemotherapeutic agents and doses.
Post-orchiectomy, modified dog-leg radiotherapy to 30 Gy in 15 fractions has been the preferred treatment in the US for stage IIA testicular seminoma over the past few decades. However, cisplatin-based chemotherapy is being used more frequently in stage IIA patients with multiple positive nodes. In contrast, chemotherapy such as bleomycin, etoposide, and cisplatin x 3 cycles has been the preferred treatment for stage IIB testicular seminoma, particularly in those with high-volume disease, since it provides superior progression-free survival.
One treatment that is under investigation for stage IIA and IIB testicular seminoma is a single course of neoadjuvant carboplatin chemotherapy followed by para-aortic radiotherapy to 30-35 Gy. Preliminary results are encouraging, though further study is needed.
Richard Wilder, MD
National Director of Radiation Oncology
Cancer Treatment Center of America
600 Celebrate Life Parkway
Newnan, GA 30265.