Chemotherapy in advanced seminoma and the role of postcytostatic retroperitoneal lymph node dissection

Between 1979 and 1992, 79 patients with seminoma were treated at our institution. Nineteen of these patients with advanced seminoma were treated with cisplatin-based chemotherapy (stage IIA, n = 2; stage IIB, n = 6; stage IIC, n = 2; stage III, n = 5 [2 with primary extragonadal tumor site]; relapse, n = 5 [1 with previously stage III seminoma]). One patient died of progressive disease 3 months after treatment with chemotherapy and retroperitoneal lymph node dissection (RPLND) which had led initially to a complete clinical response. Another patient (62 years old) died of an acute heart failure due to a sepsis caused by chemotherapy. Treatment of the other 17 patients was successful. Ten patients with a residual retroperitoneal mass after inductive chemotherapy underwent a RPLND. In 1 case viable seminoma (diameter of the residual mass 5 cm), in 4 cases necrotic tumor tissue, and in 5 cases fibrosis was diagnosed histopathologically. The 2 patients with extragonadal seminoma showed complete responses after surgery and chemotherapy. In conclusion, in patients with advanced seminoma, inductive cytostatic therapy seems to be the best treatment regimen. Residual retroperitoneal masses after chemotherapy with a diameter of >3 cm should be treated with RPLND.