Retroperitoneal Lymph Node Dissection (RPLND) as an Alternative Local Control Strategy for Patients with Low-Volume, Clinical Stage II Testicular Seminoma: Provider Survey |
Introduction
Thank you for your time and interest. This survey should take no longer than 5 minutes to complete. Your responses are invaluable to us as we continue our work into investigating this issue.
As the most common solid tumor in young adult men, there are 9,000 new testicular cancer diagnoses annually in the United States. Testicular seminoma is the most common sub-type comprising approximately 5,000 of these cases. In the setting of low-volume, retroperitoneal-only metastatic seminoma current consensus guidelines recommend retroperitoneal radiation therapy (RT). Fortunately, metastatic seminoma is considered a curable disease with cure rates approaching 99%. This is largely due to the fact that cases which relapse after local control with RT are salvageable with chemotherapy. With such successful treatment outcomes, research is now focusing on reducing the long-term therapeutic morbidities. For example, in the clinical setting of testicular seminoma, a growing body of literature associates both RT and chemotherapy with increased rates of treatment-induced second malignant neoplasms (SMN). Recent reviews have estimated that approximately 15% of men treated with radiation for this indication will experience a secondary cancer in the 25 years following treatment.
An alternative therapeutic strategy that has not been well-studied is the use of surgical retroperitoneal lymph node dissection (RPLND) for local control in low-volume, retroperitoneal-only metastatic seminoma. Currently, there are only scant reports of the use of RPLND for this indication. Primary RPLND is performed for other types of testicular cancer and substantial data exists on its side effects. By its invasive nature, surgery has more short- and intermediate-term side effects than radiation, but these are mostly minor and self-limited. In terms of long-term effects, the comparison favors surgery over radiation given that after the immediate recovery there are few side effects (Table I). Thus, while the effects of surgery and radiation can be reasonably anticipated and explained to potential patients, a major hurdle to overcome prior to studying this strategy on a larger scale is that it has rarely been done in the specific setting of testicular seminoma. In total, there are 17 reported cases in the literature of patients with low-volume, retroperitoneal-only, metastatic testicular seminoma who have been treated with surgical removal of the retroperitoneal lymph nodes. While these cases were all successful with no reports of disease recurrence, this limited evidence is insufficient for design of a larger clinical trial.
Given the favorable long-term side effect profile of surgery-alone, the use of RPLND warrants further study. The gap in the literature on the use of this novel approach makes an initial large-scale study difficult. In order to plan a clinical trial, we have developed this survey instrument to capture health-care providers’ interest in offering enrollment into a study of surgery for low-volume, retroperitoneal-only, metastatic testicular seminoma to eligible patients. These data will be used in designing future clinical trials.
As the most common solid tumor in young adult men, there are 9,000 new testicular cancer diagnoses annually in the United States. Testicular seminoma is the most common sub-type comprising approximately 5,000 of these cases. In the setting of low-volume, retroperitoneal-only metastatic seminoma current consensus guidelines recommend retroperitoneal radiation therapy (RT). Fortunately, metastatic seminoma is considered a curable disease with cure rates approaching 99%. This is largely due to the fact that cases which relapse after local control with RT are salvageable with chemotherapy. With such successful treatment outcomes, research is now focusing on reducing the long-term therapeutic morbidities. For example, in the clinical setting of testicular seminoma, a growing body of literature associates both RT and chemotherapy with increased rates of treatment-induced second malignant neoplasms (SMN). Recent reviews have estimated that approximately 15% of men treated with radiation for this indication will experience a secondary cancer in the 25 years following treatment.
An alternative therapeutic strategy that has not been well-studied is the use of surgical retroperitoneal lymph node dissection (RPLND) for local control in low-volume, retroperitoneal-only metastatic seminoma. Currently, there are only scant reports of the use of RPLND for this indication. Primary RPLND is performed for other types of testicular cancer and substantial data exists on its side effects. By its invasive nature, surgery has more short- and intermediate-term side effects than radiation, but these are mostly minor and self-limited. In terms of long-term effects, the comparison favors surgery over radiation given that after the immediate recovery there are few side effects (Table I). Thus, while the effects of surgery and radiation can be reasonably anticipated and explained to potential patients, a major hurdle to overcome prior to studying this strategy on a larger scale is that it has rarely been done in the specific setting of testicular seminoma. In total, there are 17 reported cases in the literature of patients with low-volume, retroperitoneal-only, metastatic testicular seminoma who have been treated with surgical removal of the retroperitoneal lymph nodes. While these cases were all successful with no reports of disease recurrence, this limited evidence is insufficient for design of a larger clinical trial.
Given the favorable long-term side effect profile of surgery-alone, the use of RPLND warrants further study. The gap in the literature on the use of this novel approach makes an initial large-scale study difficult. In order to plan a clinical trial, we have developed this survey instrument to capture health-care providers’ interest in offering enrollment into a study of surgery for low-volume, retroperitoneal-only, metastatic testicular seminoma to eligible patients. These data will be used in designing future clinical trials.