The treatment of advanced seminoma with chemotherapy and radiotherapy

Between 1979 and 1984 thirty-seven patients were treated with combination chemotherapy for metastatic seminoma; 27 of these had relapsed following initial radiotherapy for stage I and IIA disease and 10 patients with stage IIB-IV disease received chemotherapy de novo followed by radiotherapy to sites of bulk disease. Treatment consisted of either a cis-platinum containing combination (25 patients), or cyclophosphamide and etoposide (12 patients). The overall survival of all patients at 5 years was 49%, 34 patients were assessable for response; a CR was obtained in 8 (24%) and a GPR in 19 (56%), the 5 year survival of this group being 66% at 5 years. No difference in survival was seen in relation to age, previous irradiation, serum HCG or LDH; bulk disease however, was an adverse prognostic factor. Survival was similar for both chemotherapy schedules but neutropenia and life-threatening sepsis was less with the cyclophosphamide etoposide combination.