[Clinical outcome of refractory seminoma]

We retrospectively reviewed 67 patients with pure seminoma who were treated in our hospital between 1991 and 2009. Fifteen (22.4%) patients had metastatic or recurrent disease and underwent chemotherapy. Induction chemotherapy provided freedom from disease with no recurrence in 9 patients. On the other hand, 6 patients had chemotherapy-resistant seminoma (refractory group). We herein report the clinical features of the refractory group. Although we could not determine the risk factors for refractory disease, clinical stage III disease was resistant to induction chemotherapy. The refractory group consisted of 2 patients with recurrent disease after prophylactic radiation therapy for stage I disease, 1 with stage IIB and 3 with stage IIIC disease. In the refractory group, 3 patients obtained freedom from disease after additional chemotherapy with salvage surgery. However, 3 patients died from cancer in spite of multiple salvage treatments. Salvage radiation therapy was performed for inoperable metastatic disease in 3 patients and might have contributed to disease control in 2 patients. Some patients with pure seminoma can develop refractory disease, although the prediction is difficult. Multimodality therapy including salvage radiation possibly provides survival benefit.