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Chemotherapy of seminoma.

Publisher Summary This chapter focuses on chemotherapy, which is important in the curative treatment of advanced stages of seminoma. It is defined as retroperitoneal node metastases more than 5 cm in diameter, supradiaphragmatic node metastases, visceral metastases, and primary mediastinal disease. Historically, there was evidence of seminomas being responsive to alkylating agents, and cure was uncommon. Single-agent therapy has been investigated first with cisplatin and subsequently with carboplatin. The choice of chemotherapy can be influenced by the exquisite radiosensitivity of seminoma. When large-volume seminoma is treated with chemotherapy, a residual mass is found on CT scan in one-third to two-thirds of patients. The chemotherapy of seminoma shares with the chemotherapy of nonseminoma an extreme level of sensitivity to platinum-based chemotherapy, such that even patients with advanced and metastatic disease can be cured in a high proportion of cases. Prognostic factor analysis is less well-developed in seminoma because the indication for chemotherapy is less common.