Optimal Management of Stage II Seminoma: Preventing Harm While Preserving Cure

Stage II testicular seminoma is highly curable when treated using standard-of-care cisplatin-based chemotherapy or radiotherapy. However, these treatments can affect long-term quality of life because of the development long-term, or chronic, toxicities and late effects. In recent years, multiple emerging treatment strategies for stage II seminoma have been explored with the principal aim of minimizing toxicity in this young patient population. These strategies have included cisplatin-sparing chemotherapy, combined modality chemoradiotherapy, and surgery in the form of primary retroperitoneal lymph node dissection; small cohort studies for each approach have reported promising efficacy with minimal toxicity, albeit without long-term follow up. While there is a need to optimize and rationalize treatment to ensure that quality of life is front of mind, it is essential that the excellent outcomes using standard-of-care treatment are not taken for granted and that cure is not compromised for young patients with stage II seminoma. This review assesses the relative merits and deficiencies of each emerging treatment strategy, with one lens focused on preventing harm and the other focused on preserving disease control and cure.