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Treatment de-escalation for stage II seminoma

Nature Reviews Urology (2023)Cite this article

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Abstract

International Germ Cell Cancer Collaborative Group good-risk metastatic seminoma has cure rates of >95%. Within this risk group, patients with stage II disease exhibit the best oncological outcomes with the standard-of-care treatment strategies of radiotherapy or combination chemotherapy. However, these treatments can be associated with substantial early and late toxic effects. Therapy de-escalation aims to reduce treatment morbidity whilst preserving oncological outcomes. The evidence supporting such approaches is largely from non-randomized institutional data, and therefore this strategy is not recognized as standard of care. Current de-escalation approaches for stage II seminoma include single-agent chemotherapy, radiotherapy and surgery based on early data from clinical studies. Increased recognition of emerging data on treatment modification to reduce morbidity whilst maintaining cure rates and consideration of therapy de-escalation could improve patient survivorship outcomes.

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Fig. 1: RPLND surgical incisions and templates.

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Acknowledgements

C.A. is supported by the National Institute for Healthcare Research University College London Hospitals Biomedical Research Centre. P.R. is supported by the John Black Charitable Foundation and The Urology Foundation, the Barts Charity and the Orchid Charity.

Author information

Author notes

  1. These authors contributed equally: Constantine Alifrangis, Prabhakar Rajan.

Authors and Affiliations

  1. Department of Medical Oncology, University College London Hospitals NHS Foundation Trust, London, UK

    Georgina E. Wood & Constantine Alifrangis

  2. Department of Medical Oncology, Barts Health NHS Trust, London, UK

    Georgina E. Wood, Florence Chamberlain & Jonathan Shamash

  3. Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

    Ben Tran & Ciara Conduit

  4. Division of Personalized Medicine, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia

    Ben Tran, Ciara Conduit & Elizabeth Liow

  5. Department of Urology, The Royal Marsden Hospital NHS Foundation Trust, London, UK

    David L. Nicol

  6. National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK

    Constantine Alifrangis

  7. Centre for Cancer Cell and Molecular Biology, Barts Cancer Institute, Queen Mary University of London, London, UK

    Prabhakar Rajan

  8. Division of Surgery and Interventional Science, University College London, London, UK

    Prabhakar Rajan

  9. Department of Urology, Barts Health NHS Trust, London, UK

    Prabhakar Rajan

  10. Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK

    Prabhakar Rajan

Authors
  1. Georgina E. Wood
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  2. Florence Chamberlain
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  3. Ben Tran
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  4. Ciara Conduit
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  5. Elizabeth Liow
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  6. David L. Nicol
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  7. Jonathan Shamash
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  8. Constantine Alifrangis
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  9. Prabhakar Rajan
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Contributions

G.E.W., F.C., B.T., C.C., E.L., C.A. and P.R. researched data for the article. G.E.W., F.C., D.L.N., J.S., C.A. and P.R. contributed substantially to discussion of the content. G.E.W., C.A. and P.R. wrote the article. G.E.W., F.C., B.T., D.L.N., J.S., C.A. and P.R. reviewed and/or edited the manuscript before submission.

Corresponding authors

Correspondence to Constantine Alifrangis or Prabhakar Rajan.

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The authors declare no competing interests.

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Nature Reviews Urology thanks Michael Jewett, Phil Pierorazio and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Wood, G.E., Chamberlain, F., Tran, B. et al. Treatment de-escalation for stage II seminoma. Nat Rev Urol (2023). https://doi.org/10.1038/s41585-023-00727-0

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