Extragonadal Germ Cell Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Seminoma
The diagnosis of seminoma requires that the serum alpha fetoprotein (AFP) be normal, and no other germ cells be present. Management decisions in patients presenting with these tumors can sometimes 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. 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, as evidenced in the GER-GPO-MAKEI-86/89 trial, for example.[Level of evidence: 3iiiA]
Sedation may be considered for comfort.
Patients with advanced cancer or near the end of life may have:
A lot of emotional distress and physical pain.
Difficult and painful breathing.
Confusion (especially when body systems begin to fail).
Sedation can be given to ease these conditions. This is called palliative sedation. Deciding to use palliative sedation may be difficult for the family as well as the patient. The patient and family can get support from the health care team and...
Initial chemotherapy with regimens used in nonseminoma testicular cancer is also very efficacious. Practically speaking, patients with localized relatively small tumors are usually treated initially with radiation, 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, the majority of experts agree that observation is appropriate. In those with larger residual masses, some experts favor surgical excision while others favor observation.[3,4]
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with extragonadal seminoma. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.