Evolving the Management of Stage 2 Seminoma

FIrst, Dr. Daneshmand defines stage II seminomas, which are seminomas that have spread outside of the testicles to the retroperitoneal lymph nodes. Stage II seminomas are further subclassified into IIa, b, or c depending on size and number of affected lymph nodes. This disease stage can present on Initial seminoma diagnosis or occur after a relapse of a stage I seminoma. There are 3 options for standard treatment for stage II seminomas: radiation therapy, chemotherapy, or retroperitoneal lymph node dissection (RPLND). Dr. Daneshmand recommends a monotherapy option to minimize toxicities and explains which treatment modalities are best for each subtype of stage II seminomas. Then, the doctors discuss common side effects of each modality. Radiation may cause cardiotoxicity, fatigue, enteritis, and secondary malignancy. Chemotherapy may cause neurotoxicity, nephrotoxicity, infertility, and tinnitus or hearing loss.

The doctors also discuss RPLND as a therapeutic option. Dr. Daneshmand explains that some patients may be hesitant at first to choose this option, as this has been a large open surgery with lengthy hospitalizations in the past. However, his technique involves only making a small midline incision and using an extraperitoneal approach. His RPLND patients usually only stay in the hospital for one day and fully recover by 2 to 3 weeks. He also discusses prospective RPLND trials on stage II seminomas, including his own research project. Both doctors agree that patients should be involved in shared decision making in order to weigh the cure rate against the comorbidity rate of each therapy.

Finally, Dr. Daneshmand speculates on the future of seminoma treatment, which he believes lies in advancements of individualized treatment based on biomarker data.