A phase 2 trial demonstrated encouraging outcomes from retroperitoneal lymph node dissection (RPLND) for early metastatic testicular seminoma (stage 2). The 2-year recurrence-free survival rate was 87%, and the overall survival rate was 100% among patients who underwent the procedures [1]. National Comprehensive Cancer Network guidelines for the management of stage 2A testicular seminoma remain unchanged for several decades, recommending chemotherapy and radiation therapy. Although these interventions are associated with excellent cure rates, they are also associated with long-term morbidity as well as secondary complications such as cardiac events, secondary cancers, metabolic syndrome, and lung disease. For this reason, investigators wished to explore other therapeutic options for young men with this cancer. RPLND is commonly employed in testicular germ cell tumors, but its effectiveness in early metastatic seminoma was not yet known. The SEMS trial (NCT02537548) is a single-arm, multi-institutional phase 2 trial that studied outcomes after RPLND in stage 1-2A testicular seminoma. The trial enrolled 55 patients (median age 34 years) with testicular seminoma and isolated retroperitoneal lymphadenopathy measuring 1–3 cm to receive RPLND. The primary endpoint was recurrence-free survival at 2 years. Of the 55 patients in the trial, 14 had initial stage 1 disease and 41 had stage 2A-B. At a median follow-up period of 24 months post-RPLND, 10 participants experienced recurrence (yielding a recurrence rate of 18%). Of these patients, 8 received chemotherapy and 2 required additional surgery. The 2-year recurrence-free survival was 87% and overall survival was 100%. Within the first year of the surgery, 7 surgical complications occurred; all were deemed short-term complications. No patients have reported any long-term complications. At the time of ASCO GU 2021, Dr. Daneshmand (University of Southern California, USA) reported that these 55 patients have now been followed for 5 years, and all have survived. He, therefore, concluded that RPLND offers an effective first-line treatment option for men with testicular seminoma with retroperitoneal lymphadenopathy. The decreased long-term morbidity associated with RPLND makes it a favorable alternative.

  1. Daneshmand S. SEMS Trial: Result of a prospective, multi-institutional phase II clinical trial of surgery in early metastatic seminoma. ASCO Genitourinary Cancers Symposium, 11–13 February 2021.