This protocol addresses seminoma germ cell tumour at clinical stage IIA or IIB — defined by retroperitoneal lymph node metastasis with a lymph node mass up to 5 cm in greatest dimension — in patients whose first-line treatment has not achieved the expected response.
Historically, radiotherapy has been the primary treatment for stage IIA/IIB seminoma. Cisplatin-based chemotherapy is also a standard first-line option. This protocol applies when those prior approaches have not led to the required endpoints of tumour marker normalisation and radiological response.
First-line treatment for CS IIA/B seminoma — including cisplatin-based chemotherapy regimens such as BEP or EP, radiotherapy, nerve-sparing retroperitoneal lymph node dissection, or carboplatin plus involved-node radiotherapy — did not achieve the goals of normalisation of serum tumour markers and complete or partial radiological response on cross-sectional imaging. This failure is the indication for escalation to salvage treatment.
The aims of this next-line approach are normalisation of serum tumour markers and achieving a complete or partial radiological response. Cisplatin combination salvage chemotherapy results in long-term remissions in approximately 50% of patients who relapse after first-line chemotherapy.
The approach involves multi-agent salvage chemotherapy combining cisplatin and ifosfamide with a third cytotoxic agent. The complete selection of regimens, agents, and dosing schedule is specified in the full structured protocol.
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 regimens of choice are four cycles of a three-agent regimen including cisplatin and ifosfamide plus a third drug: etoposide (VIP), paclitaxel (TIP), or potentially gemcitabine (GIP).
Cisplatin combination salvage chemotherapy will result in long-term remissions in approximately 50% of patients who relapse after first-line chemotherapy.
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