Primary Retroperitoneal Lymph Node Dissection as Treatment for Low-volume Metastatic Seminoma in a Population-based Cohort : The Swedish Norwegian Testicular Cancer Group Experience
(2024) In European Urology Open Science 65. p.13-19- Abstract
Background and objective: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy. Methods: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per... (More)
Background and objective: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy. Methods: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS). Key findings and limitations: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13–24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16–30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4–14). PFS was 90% (95% confidence interval: 0.86–1) and OS was 100% at 24 mo. Conclusions and clinical implications: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity. Patient summary: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.
(Less)
- author
- organization
- publishing date
- 2024-07
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Germ cell cancer, Metastatic, Retroperitoneal, Retroperitoneal lymph node dissection, Robotic surgery, Seminoma, Testicular
- in
- European Urology Open Science
- volume
- 65
- pages
- 7 pages
- publisher
- Elsevier
- external identifiers
-
- pmid:38966804
- scopus:85195585539
- ISSN
- 2666-1691
- DOI
- 10.1016/j.euros.2024.05.006
- language
- English
- LU publication?
- yes
- id
- 9807d04b-ca01-4db7-86fa-fecdda5e02ad
- date added to LUP
- 2024-08-13 09:33:34
- date last changed
- 2024-08-14 03:00:02
@article{9807d04b-ca01-4db7-86fa-fecdda5e02ad,
abstract = {{<p>Background and objective: There is an unmet need to avoid long-term morbidity associated with standard cytotoxic treatment for low-volume metastatic seminoma. Our aim was to assess the oncological efficacy and surgical safety of retroperitoneal lymph node dissection (RPLND) as treatment in a population-based cohort of metastatic seminoma patients with limited retroperitoneal lymphadenopathy. Methods: Sixty-two seminoma patients in Norway and Sweden were included in the cohort from 2019 to 2022. Patients with lymphadenopathy ≤3 cm, having primary clinical stage (CS) IIA/B or CS I with a relapse, were operated with uni- or bilateral template RPLND, open or robot assisted. The outcome measures included surgical complications as per Clavien-Dindo, and Kaplan-Meier survival estimates for 24-mo progression-free survival (PFS) and overall survival (OS). Key findings and limitations: In the cohort, 33 (53%) had CS I with a relapse during surveillance, six (10%) CS I with a relapse following adjuvant chemotherapy, and 23 (37%) initial CS IIA/B. Metastatic seminoma was verified in 58 patients (94%) with a median largest diameter of 18 mm (interquartile range [IQR] 13–24). Robot-assisted RPLND was performed in 40 patients (65%). Clavien-Dindo III complications were observed in three patients (5%); no grade ≥IV complications occurred. Eighteen patients (29%) received adjuvant chemotherapy after surgery. The median follow-up was 23 mo (IQR 16–30), and recurrence occurred in six patients (10%) after a median of 8 mo (IQR 4–14). PFS was 90% (95% confidence interval: 0.86–1) and OS was 100% at 24 mo. Conclusions and clinical implications: RPLND as primary treatment is an option for selected low-stage seminomas with a limited burden of disease, showing low complications and low relapse rates, with the potential to reduce long-term morbidity. Patient summary: In seminoma patients with limited metastatic spread, surgery is a treatment option offering an alternative to chemotherapy or radiation. This paper covers the first 62 patients operated in Norway and Sweden.</p>}},
author = {{Thor, Anna and Negaard, Helene F.S. and Grenabo Bergdahl, Anna and Almås, Bjarte and Melsen Larsen, Signe and Lundgren, Per Olof and Gerdtsson, Axel and Halvorsen, Dag and Johannsdottir, Berglind and Jansson, Anna K. and Hellström, Martin and Wahlqvist, Rolf and Langberg, Carl W. and Hedlund, Annika and Akre, Olof and Glimelius, Ingrid and Ståhl, Olof and Haugnes, Hege Sagstuen and Cohn-Cedermark, Gabriella and Kjellman, Anders and Tandstad, Torgrim}},
issn = {{2666-1691}},
keywords = {{Germ cell cancer; Metastatic; Retroperitoneal; Retroperitoneal lymph node dissection; Robotic surgery; Seminoma; Testicular}},
language = {{eng}},
pages = {{13--19}},
publisher = {{Elsevier}},
series = {{European Urology Open Science}},
title = {{Primary Retroperitoneal Lymph Node Dissection as Treatment for Low-volume Metastatic Seminoma in a Population-based Cohort : The Swedish Norwegian Testicular Cancer Group Experience}},
url = {{http://dx.doi.org/10.1016/j.euros.2024.05.006}},
doi = {{10.1016/j.euros.2024.05.006}},
volume = {{65}},
year = {{2024}},
}