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 i nstitution. Nineteen of these patients with advanced seminoma were tre ated 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]). O ne patient died of progressive disease 3 months after treatment with c hemotherapy and retroperitoneal lymph node dissection (RPLND) which ha d led initially to a complete clinical response. Another patient (62 y ears old) died of an acute heart failure due to a sepsis caused by che motherapy. Treatment of the other 17 patients was successful. Ten pati ents with a residual retroperitoneal mass after inductive chemotherapy underwent a RPLND. In 1 case viable seminoma (diameter of the residua l mass 5 cm), in 4 cases necrotic tumor tissue, and in 5 cases fibrosi s 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 t herapy seems to be the best treatment regimen. Residual retroperitonea l masses after chemotherapy with a diameter of >3 cm should be treated with RPLND.