Seminoma medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

The optimal therapy for seminoma depends on the stage at diagnosis.

Medical Therapy

• In case of seminoma, the healthcare team creates an individualized treatment plan. It is generally based on the patient's needs and may include a combination of different treatments. The factors which help in deciding the treatment plan for seminoma include:

• Stage of seminoma
• Risk of recurrence
• Fertility
• Preferences of the individual

• The various treatment options depending on the stage and recurrence risk of seminoma are discussed below.

Treatment of Seminoma

Stage I

Stage II

Stage III

Recurrent

❑ Surgery ❑ Active surveillance ❑ Radiotherapy ❑ Chemotherapy

❑ Surgery ❑ Radiotherapy ❑ Chemotherapy

❑ Surgery ❑ Chemotherapy

❑ Standard-Dose Chemotherapy ❑ High-Dose Chemotherapy with Stem Cell Transplant ❑ Surgery

Chemotherapy

• Chemotherapy is a common treatment for all stages of seminoma. It is usually given after an orchiectomy. A combination of chemotherapy drugs is usually given.
• BEP is the main chemotherapy combination used for seminoma. It includes bleomycin, etoposide, and cisplatin.
• Sometimes, physicians just give etoposide and cisplatin (called EP). EP is given when bleomycin affects the lungs (called pulmonary toxicity), or there is a high risk that it will cause lung damage.
• High-dose chemotherapy and stem cell transplant may be used for recurrent testicular cancer, if the standard-dose chemotherapy doesn’t work and the cancer comes back.
• High doses of carboplatin and etoposide are given. After high-dose chemotherapy, a stem cell transplant is done to replace the stem cells that are damaged or destroyed by high-dose chemotherapy. The stem cell transplant is an autologous peripheral blood stem cell transplant.

Radiotherapy

• Seminoma is a radiosensitive tumor (vs. nonseminomatous germ cell tumors)
• Radiation therapy may be used to treat stage I or II seminomas after orchiectomy.
• It is given as external beam radiation therapy.
• Radiation is directed at the lymph nodes in the abdomen and pelvis.

Active Surveillance

• Active surveillance is the preferred treatment for stage I seminoma after a radical inguinal orchiectomy.
• During active surveillance, the healthcare team watches for any signs and symptoms of recurrence. Treatment is given only if seminoma recurs.
• There are no standard active surveillance schedules for seminoma. Active surveillance may last for 5-10 years. You may have follow-up visits every 2-6 months for the first 3 years.
• Tests that are often done during a follow-up visit include:

• Physical exam
• Blood tests to check serum tumor marker levels
• Chest x-ray
• CT scan of the abdomen