Treatment of Seminoma

The diagnosis of seminoma requires that the serum alpha-fetoprotein be normal, with no other germ cells present. Management decisions in patients presenting with these tumors can be difficult.

As in testicular seminoma, these tumors are very radiosensitive. About 60% to 80% of patients will remain disease free after treatment with radiation therapy.[1] Craniospinal radiation therapy for intracranial germinomas (the intracranial counterpart of seminoma) is associated with relapse-free and overall survival rates of 90% to 95% at 5 years, respectively, as evidenced in the GER-GPO-MAKEI-86/89 trial, for example.[2][Level of evidence C1]

Initial chemotherapy with regimens used in nonseminoma testicular cancer is also efficacious. Practically speaking, patients with localized relatively small tumors are usually treated initially with radiation therapy, while those with very bulky tumors or nonlocalized tumors are treated with etoposide-based and cisplatin-based chemotherapy regimens.

As in testicular seminoma, many patients will be left with a residual mass posttreatment. If the residual mass is smaller than 3.0 cm, most experts agree that observation is appropriate. In those with larger residual masses, some experts favor surgical excision while others favor observation.[3,4]