Clinical Update on TesticularTumor : Treatment of Seminoma

Abstract

Testicular germ cell tumor is the most common malignant tumor in men aged 20 to 35 years. It represents about 1% of malignant tumors occurring in men, and its incidence has been rising steadily. The treatment of testicular germ cell tumor has made tremendous leaps over the last decades and shows the highest cure rate among all malignant tumors. Testicular germ cell tumor is histopathologically classified into seminoma and nonseminomatous germ cell tumor. Seminoma represents about 50% of testicular germ cell tumor, and its clinical characteristics include peak incidence at the 4th decade, a high probability of stage I disease and an excellent cure rate even in advanced stage diseases. Recent trends in the treatment of seminoma have been focused on minimizing toxicity in low stage diseases and maximizing survival in high stage diseases. Seminoma is extremely radiosensitive and radiotherapy has been the mainstay of treatment for low stage diseases. Refinements in the technique of radiation delivery by reducing fields and doses of radiation have resulted in a decrease of acute toxicity rate, albeit preserving the high cure rate of more conventional techniques. The use of surveillance protocol has remained limited, while the role of chemotherapy has expanded for stage I seminoma. Carboplatin monotherapy has shown good early results comparable to those of radiotherapy with potential advantages of being devoid of risk of a second primary malignancy and cardiac complications seen with radiotherapy. It awaits longer term follow-up results to be established as a standard therapy in the treatment of stage I seminoma. Advanced seminoma treated with cisplatin-based chemotherapy shows a cure rate exceeding 85%. For residual tumors after primary chemotherapy, close follow-up is generally preferred over surgery due to high rate of failure and complications. A more potent salvage chemotherapeutic regimen should be developed in the future for recurrent tumors after primary chemotherapy.