Early stage and advanced seminoma: role of radiation therapy, surgery, and chemotherapy

Testicular seminoma is an uncommon tumor that accounts for approximately 50% of all germ cell testicular tumors. The vast majority of patients present with early-stage disease and almost all patients are cured of their disease. Management is based on disease extent with patients with stage I seminoma having numerous treatment options, varying from surveillance to adjuvant retroperitoneal radiation therapy and prophylactic adjuvant single-agent chemotherapy. Only 20% of patients present with more advanced disease; the majority of those have stage II disease with retroperitoneal lymph node involvement. The standard management is retroperitoneal radiation therapy with chemotherapy being used for patients with bulky disease. Systemic chemotherapy with cisplatin alone or etoposide and cisplatin is the standard approach to advanced and metastatic disease with cure rates approaching 85% to 90%. The goal of treatment is a cure with a minimum of complications. The current controversies include the optimum management of residual retroperitoneal mass (post-radiation therapy or chemotherapy), the management of patients with second testicular or bilateral testicular tumors, the management of testicular intraepithelial neoplasia, and the management of seminoma in immunosuppressed patients.