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Lymph Node Removal Procedure as First-Line Treatment for Testicular Seminoma Associated with Favorable Survival Rates

Rutgers Cancer Institute of New Jersey investigator presents findings at national meeting
February 12, 2019

New Brunswick, N.J. – Investigators at Rutgers Cancer Institute of New Jersey have found that a surgical procedure, when used as a first-line therapy for a form of testicular cancer known as seminoma, is associated with favorable survival rates. Traditionally, these patients are treated with chemotherapy or radiation therapy, but these treatments may be associated with significant long-term side effects. Results of the work will be presented at the 2019 Genitourinary Cancers Symposium (co-sponsored by the American Society of Clinical Oncology, American Society for Radiation Oncology and the Society of Urologic Oncology) in San Francisco later this week.

Some men with testicular cancer undergo a complex surgical procedure known as retroperitoneal lymph node dissection (RPLND) to remove abdominal lymph nodes or masses that persist after chemotherapy. Theoretically, RPLND may potentially be associated with less long-term side effects than the current treatments available for these men.  However, the role of RPLND as a first-line treatment for a form of testicular cancer known as a seminoma is less well defined than for that of testicular non-seminomas.  Rutgers Cancer Institute urologic oncologist Thomas L. Jang, MD, MPH, FACS, and colleagues examined utilization rates of RPLND in the United States for men with testicular seminoma and report on survival outcomes when the procedure is offered as a first-line treatment or in select patients who receive the procedure after chemotherapy.

Using 2004 – 2014 data from the National Cancer Database, 412 men with testicular seminoma who underwent RPLND and met other criteria were identified for the cohort. Among these men, 89 percent received RPLND as first-line treatment, while 11 percent had RPLND after chemotherapy. The investigators note there were no significant differences in clinical or demographic characteristics when comparing men in these two groups. Median follow-up was 4.1 years. Five-year overall survival was 94.2 percent in men who received RPLND as first line treatment and 89.0 percent in those who received the procedure after chemotherapy.  When examining men with Stage I and IIA/B seminoma who received RPLND as first line treatment, the investigators noted five-year overall survival rates of 97.3 percent and 92.0 percent, respectively.  These results were statistically significant, say the authors.  Overall survival did not significantly differ in seminoma patients with Stage IIA versus IIB disease (91.8 percent versus 92.3 percent, respectively).

“Though RPLND is rarely used as primary therapy in these men, overall survival rates appear to be favorable. Our findings are directional and ultimately, ongoing prospective trials, such as the SEMS (Surgery in Early Metastatic Seminoma) trial, will clarify the role of surgery in this setting,” notes Dr. Jang, who is the senior and corresponding author on the work as well as an assistant professor of surgery at Rutgers Robert Wood Johnson Medical School.

Other authors on the work are Alexandra Tabakin, MD, Rutgers Robert Wood Johnson Medical School; Sinae Kim, PhD, Rutgers Cancer Institute; Charles Polotti, MD, and Brian Shinder, MD, both Rutgers Robert Wood Johnson Medical School; Zorimar Rivera-Núñez, PhD, Rutgers Cancer Institute; Joshua Sterling, MD, MS, Nicholas Farber, MD, and Kushan D. Radadia, MD, all Rutgers Robert Wood Johnson Medical School; and Tina Mayer, MD, Isaac Yi Kim, MD, PhD, MBA, and Eric Singer, MD, MA, both of Rutgers Cancer Institute and Rutgers Robert Wood Johnson Medical School.

About Rutgers Cancer Institute of New Jersey

As New Jersey’s only National Cancer Institute-designated Comprehensive Cancer Center, Rutgers Cancer Institute, along with its partner RWJBarnabas Health, offers the most advanced cancer treatment options including bone marrow transplantation, proton therapy and CAR-T cell therapy.  Along with clinical trials and novel therapeutics such as precision medicine and immunotherapy – many of which are not widely available – patients have access to these cutting-edge therapies at Rutgers Cancer Institute of New Jersey in New Brunswick, Rutgers Cancer Institute of New Jersey at University Hospital in Newark, as well as through RWJBarnabas Health facilities.

Along with world-class treatment, which is often fueled by on-site research conducted in Rutgers Cancer Institute laboratories, patients and their families also can seek cancer preventative services and education resources throughout the Rutgers Cancer Institute and RWJBarnabas Health footprint statewide. To make a tax-deductible gift to support the Cancer Institute of New Jersey, call 848-932-8013 or visit www.cinj.org/giving.

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