Retroperitoneal lymph node dissection conferred favorable survival rates among men with testicular seminoma used as first-line therapy or following chemotherapy, according to study results presented at Genitourinary Cancers Symposium. “Although retroperitoneal lymph node dissection is rarely used as primary therapy in these men; overall survival rates appear to be favorable,” Thomas L. Jang, MD, MPH, FACS, a urologic oncologist and assistant professor of surgery at Rutgers Robert Wood Johnson Medical School; said in a press release.
“Our findings are directional and ultimately, ongoing prospective trials, such as the SEMS (Surgery in Early Metastatic Seminoma) trial; will clarify the role of surgery in this setting.” The use of retroperitoneal lymph node dissection as first-line therapy for testicular seminoma is not as well defined as it is for nonseminomas.
Also; it can be challenging to perform retroperitoneal lymph node dissection following chemotherapy for patients with PET avid residual masses larger than 3 cm. Jang and colleagues used 2004 to 2014 data from the National Cancer Database to evaluate the use of retroperitoneal lymph node dissection in the primary and post-chemotherapy settings and its impact on OS.
Researchers identified 62,727 men with primary testicular cancer, 31,068 of whom had seminoma. After excluding men with benign, nongerm cell and nonseminoma histologies; those who did not undergo retroperitoneal lymph node dissection; and those without a clinical stage or survival data, the final cohort included 412 men.
Eighty-nine % of the cohort (n = 365; median age, 40 years; range 0-81) underwent retroperitoneal lymph node dissection in the first-line setting and the other 11% did so following chemotherapy. because Researchers did not observe major differences between these two groups.
Most men undergoing retroperitoneal lymph node dissection after chemotherapy were treated at an academic medical center (63.8%) or a comprehensive community cancer program (21.3%). Median follow-up was 4.1 years. Researchers reported 5-year OS rates of 94.2% for those receiving first-line retroperitoneal lymph node dissection; and 89% for those receiving retroperitoneal lymph node dissection following chemotherapy.
“Although retroperitoneal lymph node dissection is rarely use as first-line therapy in testicular seminoma; overall survival rates appear to be excellent; as they do for men with testicular seminoma after post-chemotherapy retroperitoneal lymph node dissection;” the researchers wrote. Because “Ongoing trials evaluating the use of retroperitoneal lymph node dissection for an early metastatic; low-volume disease will clarify its role in the management of testicular seminoma.”
Retroperitoneal exploration at the time of primary debulking surgery appeared to improve survival in patients with intraperitoneal stage IIIC optimally debulked epithelial ovarian cancer; according to data collected from a large multi-institutional trial. Based on the previous FIGO staging system; “approximately 10% to 25% of patients with presumed early-stage disease confined to the ovaries or pelvis have been upgraded to stage III disease due to retroperitoneal lymph node metastasis identified during thorough surgical staging.
” Bunja J. Rungruang, MD, assistant professor of gynecologic oncology at Medical College of Georgia of Augusta University, and colleagues wrote. because “Although retroperitoneal and intraperitoneal disease burden are both prognostically important; patients with an advanced-stage disease by positive lymph nodes alone have improved survival compared with those with ba ulky peritoneal disease.”