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<p>Of patients with a&#xa0;seminomatous germ cell tumor (KZT), 10–15% present in clinical stage&#xa0;IIA/B. The previous standards of systemic chemotherapy with three cycles of PEB (cisplatin, etoposide, bleomycin) or four cycles of PE (cisplatin and etoposide) or radiotherapy of the infradiaphragmatic, paraaortic, and ipsilateral pelvic lymphatic drainage pathways with doses of 30 Gy (clinical stage&#xa0;IIA) and 36 Gy (clinical stage&#xa0;IIB) show excellent disease-free survival rates of 90–95%. However, both treatment options are associated with a&#xa0;significantly increased rate of cardiovascular, metabolic, and oncological long-term toxicities as well as an increased treatment-related long-term mortality risk. Since the majority of patients with low retroperitoneal metastasis burden are long-term survivors, it seems particularly important to develop de-escalating treatment options that combine low toxicity with high oncological effectiveness. De-escalating chemoradiotherapy involves administration of a&#xa0;cycle of carboplatin in area under the curve (AUC)7 followed by involved-node radiotherapy at 30–36 Gy. A&#xa0;total of 120&#xa0;patients with pure seminoma in clinical stage&#xa0;IIA/B were recruited, who had disease-free survival after&#xa0;3 and 10&#xa0;years of 93.7% and 92.8%, respectively. Retroperitoneal lymphadenectomy included 296&#xa0;patients in four prospective and two retrospective studies, all of whom were treated at specialized centers with appropriate surgical expertise. With a&#xa0;median follow-up of 20–50&#xa0;months, a&#xa0;recurrence rate of 11–30% has been described. As with chemoradiotherapy, the treatment-associated side effects were low, and all relapsed patients could be cured by salvage chemotherapy. These two innovative treatment options should replace the old standards and be transferred to the clinical algorithm.</p>

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Deeskalierende Therapie beim Seminom im klinischen Stadium IIA/B: nervschonende retroperitoneale Lymphadenektomie oder Radiochemotherapie

  • 期刊论文

  • 发表日期：

    2026年2月11日

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  • Axel Heidenreich,
  • Alexandros Papachristofilou

摘要

Of patients with a seminomatous germ cell tumor (KZT), 10–15% present in clinical stage IIA/B. The previous standards of systemic chemotherapy with three cycles of PEB (cisplatin, etoposide, bleomycin) or four cycles of PE (cisplatin and etoposide) or radiotherapy of the infradiaphragmatic, paraaortic, and ipsilateral pelvic lymphatic drainage pathways with doses of 30 Gy (clinical stage IIA) and 36 Gy (clinical stage IIB) show excellent disease-free survival rates of 90–95%. However, both treatment options are associated with a significantly increased rate of cardiovascular, metabolic, and oncological long-term toxicities as well as an increased treatment-related long-term mortality risk. Since the majority of patients with low retroperitoneal metastasis burden are long-term survivors, it seems particularly important to develop de-escalating treatment options that combine low toxicity with high oncological effectiveness. De-escalating chemoradiotherapy involves administration of a cycle of carboplatin in area under the curve (AUC)7 followed by involved-node radiotherapy at 30–36 Gy. A total of 120 patients with pure seminoma in clinical stage IIA/B were recruited, who had disease-free survival after 3 and 10 years of 93.7% and 92.8%, respectively. Retroperitoneal lymphadenectomy included 296 patients in four prospective and two retrospective studies, all of whom were treated at specialized centers with appropriate surgical expertise. With a median follow-up of 20–50 months, a recurrence rate of 11–30% has been described. As with chemoradiotherapy, the treatment-associated side effects were low, and all relapsed patients could be cured by salvage chemotherapy. These two innovative treatment options should replace the old standards and be transferred to the clinical algorithm.