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Surgery found to be a feasible stand-alone treatment for early metastatic testicular cancer

Article

"We are confident that surgery for [testicular seminoma] will be included into treatment guidelines in the near future,” says Sia Daneshmand, MD.

Recent findings published in the Journal of Clinical Oncology found retroperitoneal lymph node dissection (RPLND) to be a feasible alternative to radiation and chemotherapy in the treatment of patients with early metastatic testicular cancer.1,2

The phase 2 trial enrolled 55 patients with testicular seminoma across 12 institutions in the United States and Canada.

The phase 2 trial enrolled 55 patients with testicular seminoma across 12 institutions in the United States and Canada.

“We found that the majority of participants in the study were cured with surgery alone, avoiding the toxicities associated with traditional therapies. We are confident that surgery for this disease state will be included into treatment guidelines in the near future,” said lead investigator, Sia Daneshmand, MD, in a news release on the findings.2 Daneshmand is a urologic oncologist at Keck Medicine of the University of Southern California in Los Angeles.

The phase 2 trial (NCT02537548) enrolled 55 patients with testicular seminoma across 12 institutions in the United States and Canada. Patients all had clinically low-volume retroperitoneal lymphadenopathy, with a median largest clinical lymph node size of 1.6 cm.Among all participants, 9 (16%) were pN0, 12 (22%) were pN1, 31 (56%) were pN2, and 3 (5%) were pN3.

Median follow-up time was 33 months. The primary end point was 2-year recurrence free survival (RFS).

The investigators found that surgery was associated with a 2-year RFS rate of 81% among all patients. Patients who did have an instance of recurrence (22%) were successfully treated with chemotherapy (n=10) or additional surgery (n=2) after the initial RPLND procedure. All patients who experienced a recurrence were disease-free at final follow-up. The overall survival rate at 2 years was 100%.

Most patients had minimal or no complications after surgery and were able to go home after 24 hours. Short-term complications from the procedure were experienced by 4 patients (7%). Long-term complications were experienced by 4 patients (7%), as well, and included incisional hernia (n=1) and anejaculation (n=3).

“Early metastatic seminoma has a very high survival rate; however, if treated with chemotherapy and radiation, the cure can come at a high cost. Surgery gives patients both the opportunity to be cured and experience a high quality of life post-cancer,” concluded Daneshmand in the news release.2 

References

1. Daneshmand S, Cary C, Masterson T, et al. Surgery in early metastatic seminoma: A phase II trial of retroperitoneal lymph node dissection for testicular seminoma with limited retroperitoneal lymphadenopathy [published online ahead of print Mar 13, 2023]. J Clin Oncol. doi: 10.1200/JCO.22.00624.

2. Surgery proves effective alternative to chemotherapy and radiation for early metastatic testicular cancer. News release. Keck Medicine of USC. March 30, 2023. Accessed April 3, 2023. https://www.newswise.com/articles/surgery-proves-effective-alternative-to-chemotherapy-and-radiation-for-early-metastatic-testicular-cancer?sc=mwhr&xy=10016681

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