Instead, surgery to remove lymph nodes in an area behind the abdomen lining called the retroperitoneum may be enough, according to their new study.
“We found that the majority of participants in the study were cured with surgery alone, avoiding the toxicities associated with traditional therapies. We are confident that surgery for this disease state will be included into treatment guidelines in the near future,” said lead investigator Dr. Sia Daneshmand, a urologic oncologist at Keck Medicine of the University of Southern California and a member of USC Norris Comprehensive Cancer Center.
Testicular cancer is typically treatable and most commonly affects younger men, ages 15 to 35.
When it only spreads to the retroperitoneum, it is classified as early metastatic or stage 2 seminoma. Seminoma is a slow-growing type of testicular cancer.
Standard treatment is chemotherapy and radiation to shrink and kill the cancer in the lymph nodes, though when that fails, surgery is often done. But surgery has not historically been used as a standalone treatment for this metastatic cancer.
However, chemotherapy and radiation are associated with long-term side effects that include heart disease and secondary cancers.
To study the issue, the researchers enrolled 55 patients from 12 institutions.
Patients had previously undergone surgery to remove the testicle or testicles where the original cancer occurred, and their cancer had progressed no further than to the retroperitoneum.
Once in the study, patients underwent removal of these lymph nodes by certified surgeons at participating institutions around the United States and at one site in Canada.
About 81% of the patients were still free of recurrence two years later. The 20% who had recurrent cancer were successfully treated with either chemotherapy or additional surgery for an overall survival rate of 100%.
“A 100% survival suggests that a cure can still be achieved even in patients who experience recurrence after the surgery,” Daneshmand noted in a Keck news release.
“Early metastatic seminoma has a very high survival rate; however, if treated with chemotherapy and radiation, the cure can come at a high cost,” he said. “Surgery gives patients both the opportunity to be cured and experience a high quality of life post-cancer.”
The findings were published recently in the Journal of Clinical Oncology.
The American Cancer Society has more on testicular cancer.
SOURCE: Keck Medicine of USC, news release, March 30, 2023
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