Treatment of advanced seminoma

Many recent publications indicate a growing dissatisfaction with the results of radiation therapy for advanced seminoma, and have shown superior results with an approach based on initial chemotherapy. Moreover, previous radiation therapy is not innocuous, and therefore chemotherapy should be the initial mode of therapy for advanced seminoma, and not be reserved for radiation therapy failures. Prior radiation not only enhances the toxicity of subsequent chemotherapy, but may also compromise the efficacy of chemotherapy. The results of combination chemotherapy for advanced seminoma, particularly with regimens which include cis-platinum, have been uniformly good when chemotherapy is employed initially. Failure of advanced seminoma to respond to primary chemotherapy is a rare event, indicating that seminomas are highly sensitive to combination chemotherapy. In the event of complete response, no further therapy may be indicated, since adjunctive surgery in these cases rarely shows evidence of persistent viable tumor. In addition, it has been our experience and that of others that lymphadenectomy after cytoreductive chemotherapy for advanced seminoma presents a more difficult surgical exercise than in the case of nonseminomatous tumors (Walther, Paulson 1984; Vugrin, Whitmore 1984). Whether follow-up radiation in complete response to chemotherapy will lower subsequent relapse rates has not been demonstrated. When partial response occurs, therapeutic options include further chemotherapy, surgery, or radiation. The relative roles of the varying approaches have yet to be determined. To maximize cure rates, additional progress will have to be made in several areas. Efforts to standardize the staging of advanced disease so that the results of different treatment modes can be more readily compared are critical.(ABSTRACT TRUNCATED AT 250 WORDS)