Retroperitoneal Lymph Node Dissection as Primary Treatment for Metastatic Seminoma

Abstract EN

Reducing the long-term morbidity in testicular cancer survivors represents a major area of interest.

External beam radiation therapy and systemic chemotherapy are established treatments for seminoma; however, they are associated with late toxicities such as cardiovascular disease, insulin resistance, and secondary malignancy.

Retroperitoneal lymph node dissection (RPLND) is a standard treatment for nonseminomatous germ cell tumors (NSGCT) that has minimal long-term morbidity.

Given the efficacy of RPLND in management of NSGCT, interest has developed in this surgery as a front-line treatment for seminoma with isolated lymph node metastasis to the retroperitoneum.

Four retrospective studies have shown promising results when surgery is performed for seminomas with low-volume retroperitoneal metastases.

To better determine if RPLND can be recommended as a primary treatment option, two prospective clinical trials (SEMS and PRIMETEST) are underway.

This review will examine the literature, discuss the benefits/limitations of RPLND, and compare the methodologies of the two ongoing clinical trials.