Treatment of Testicular Cancer in Seminoma — Clinical Stage IIA or IIB with Retroperitoneal Lymph Node Metastasis

This protocol addresses the management of seminoma germ cell tumour at clinical stage IIA or IIB, characterised by retroperitoneal lymph node metastasis with a nodal mass up to 5 cm in greatest dimension.

Clinical scenario

The patient has confirmed seminoma with regional spread to retroperitoneal lymph nodes. Both radiotherapy and cisplatin-based chemotherapy are established first-line options for this stage, each carrying distinct long-term toxicity profiles that should be discussed with the patient when choosing between them. Historically, radiotherapy has been the primary treatment for stage IIA/B seminoma, with relapse rates of 5–11%; chemotherapy is equally a standard option at this stage.

Treatment approach (partial)

Management may involve cisplatin-based chemotherapy or radiotherapy to the retroperitoneal region, with the choice guided by disease volume, patient characteristics, and suitability for specific agents. In carefully selected marker-negative low-volume cases managed at expert centres, a surgical approach is also an option. The full regimen choices, sequencing, and decision criteria are available in the complete protocol.

Treatment goals

Normalisation of serum tumour markers
Complete or partial radiological response on cross-sectional imaging

Instant Access to Structured Evidence-Based Regimens

References

Historically, radiotherapy has been the primary treatment for stage II A/B seminoma, showing relapse rates between 5–11%.

Chemotherapy is a standard option for stage IIA/B seminoma.

The standard regimen in stage II seminoma is BEP x 3 or EP x 4 if there are concerns with the use of bleomycin.

Nerve sparing RPLND for marker-negative clinical stage IIA/B seminoma is associated with a low rate of treatment-associated morbidity, a chemotherapy-free survival of 80 to 85% if performed in expert hands and can be recommended as a primary treatment option in patients with low-volume metastatic lymph nodes ≤ 3 cm in diameter.

Offer cisplatin chemotherapy according to IGCCCG prognosis groups, or alternatively radiotherapy to seminoma patients with stage II A/B and, inform the patient of potential long-term side effects of both treatment options.

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