[Management of advanced seminoma: retrospective study of 96 patients].

Aim of the Study: We report the results of a retrospective study in 96 patients with advanced seminoma, who received first line chemotherapy at the centre Léon-Bérard from 1980 to 2000.
Patients and Methods: The primary site of disease was gonadonal in 88 patients and extragonadal in 8 others. Among the 96 patients, 8 patients had an atypic seminoma and 88 a classical seminoma. Extranodal metastases were present in 25 patients, metastatic site was unique in 69 patients. Except 9 patients, all had a good prognosis according to the IGCCCG. All patients had normal serum AFP level at diagnosis. Ten and 38 patients had elevated hCG and LDH serum marker level respectively.
Results: After first line chemotherapy, 18 patients achieved a complete response (CR) and 73 a marker negative partial response (PR-). Two presented a marker positive partial response (PR+), and two others, a progressive disease (PD). One toxic death occurred after first cycle of chemotherapy. Seventy-seven patients had residual masses. Resection was performed in 27 patients with PR- and led to 18 CR. Only two of the 27 residual mass contained active tumor. After chemotherapy and additional treatment as surgery or radiotherapy, a residual mass was still present in 55 patients but disappeared spontaneously for 23 of them. Relapse occurred in 18 patients, 16 of whom received salvage chemotherapy. A favourable response was observed in 9 patients with 6 complete responses. Despite this treatment, 14 patients eventually died. No adverse prognostic factor such as primary extragonodal site, prior radiotherapy, number of metastastic sites, international classification, serum markers levels (hCG, LDH) was found. The 5-years overall survival rate was 78%.
Conclusion: This study show the poor outcome of patients with advanced seminoma after relapse. Renewed efforts are required to identify specific markers in seminoma in order to optimize treatment at initial presentation. Spontaneous regression of residual mass is frequent, thus an observation can be proposed without indication of immediate additional treatment, as surgery.