Editorial Comment

You have accessJournal of UrologyOriginal Research Articles1 Jan 2024Editorial CommentThis article comments on the following:Primary Retroperitoneal Lymph Node Dissection for Seminoma Metastatic to the Retroperitoneum Rachel Passarelli and Thomas L. Jang Rachel PassarelliRachel Passarelli Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey More articles by this author and Thomas L. JangThomas L. Jang Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003697.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Cisplatin-based chemotherapy regimens and radiation therapy to the regional lymph nodes are well-established options to treat men with low-volume metastatic seminoma to the retroperitoneum (stage IIA/B). Though cure rates approach and/or exceed 90% with either approach, these therapies may be associated with long-term toxicities including pulmonary fibrosis, ototoxicity, nephrotoxity, cardiotoxicity, and increased risk for secondary cancers. In this distinctively young population where long-term survival should be an expectation, treatments have focused on minimizing morbidity. Retroperitoneal lymph node dissection (RPLND) has been proposed as an alternate treatment strategy for patients with low-volume metastatic seminoma because of its established efficacy, safety, and few long-term complications in the nonseminoma population when performed by high-volume providers at experienced centers. The role of primary RPLND in early metastatic seminoma has recently been clarified by data from several prospective phase II trials (SEMS, PRIMETEST, COTRIMS). Though the inclusion criteria (number and size of lymph nodes), surgical approach, and templates varied according to trial, recurrence-free survival was 78%, 70%, and 90% at median follow-up of 33 months, 32 months, and 21 months in the SEMS, PRIMETEST, and COTRIMS trials, respectively.1-3 In the present study, investigators from Memorial Sloan Kettering Cancer Center report a retrospective review of their 10-year experience in treating 45 men with testicular seminoma metastatic to the retroperitoneum.4 Taking into account that almost 20% of men with pN1 disease received adjuvant chemotherapy in this cohort despite having undergone an RPLND, this experienced group from Memorial Sloan Kettering report outcomes (2-year recurrence-free survival of 81%) analogous to those reported in prospective trials. Anejaculatory rates following RPLND were not reported, though ejaculatory dysfunction rates post-RPLND reported in SEMS trial appear low (5%).1 Taken together, data from this study add to the emerging literature corroborating the early oncologic efficacy and low complication rate of primary RPLND for patients with early metastatic seminoma. REFERENCES 1. Surgery in early metastatic seminoma: a phase II trial of retroperitoneal lymph node dissection for testicular seminoma with limited retroperitoneal lymphadenopathy. J Clin Oncol. 2023; 41(16):3009-3018. Crossref, Medline, Google Scholar 2. Phase 2 single-arm trial of primary retroperitoneal lymph node dissection in patients with seminomatous testicular germ cell tumors with clinical stage IIA/B (PRIMETEST). Eur Urol. 2023; 84(1):25-31. Crossref, Medline, Google Scholar 3. . Retroperitoneal lymph node dissection in clinical stage IIA/B metastatic seminoma: results of the COlogne Trial of Retroperitoneal Lymphadenectomy In Metastatic Seminoma (COTRIMS). Eur Urol Oncol. 2023; 10.1016/j.euo.2023.06.004. Crossref, Google Scholar 4. Primary retroperitoneal lymph node dissection for seminoma metastatic to the retroperitoneum. J Urol. 2024; 211(1):80-89. Abstract, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology6 Sep 2023Primary Retroperitoneal Lymph Node Dissection for Seminoma Metastatic to the Retroperitoneum Volume 211 Issue 1 January 2024 Page: 88-89 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Metrics Author Information Rachel Passarelli Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey More articles by this author Thomas L. Jang Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...