BEP for Stage II Seminoma (Garcia-del-Muro)

Background

Spanish multicenter prospective study of primary BEP chemotherapy for stage IIA/IIB seminoma. 72 patients from 18 institutions treated as an alternative to radiotherapy. All had stage IIA (nodes 1–2 cm) or IIB (2–5 cm) seminoma. Median follow-up 71.5 months.

Interventions and follow up

Regimen: BEP ×3 cycles (bleomycin, etoposide, cisplatin) at standard doses, or EP ×4 in bleomycin-contraindicated patients; no radiotherapy (n=72)
Primary endpoint: Complete response rate and progression-free survival
Median follow up: 71.5 months

Results

5-yr progression-free survival: 90%
Relapses: 7 of 72 patients
Stage IIB outcomes: Slightly inferior to IIA, consistent with larger nodal burden
Overall survival: High disease-specific survival; deaths predominantly unrelated to seminoma

Adverse events

Hematologic: Grade 3–4 myelosuppression in a substantial fraction during BEP cycles
Pulmonary/other: Bleomycin-related pulmonary toxicity in a minority; nausea/emesis common; toxicity overall manageable

Conclusions

Primary BEP ×3 (or EP ×4) achieves high progression-free survival in stage IIA/IIB seminoma, providing an effective alternative to radiotherapy that avoids radiation late effects while curing the vast majority.

Key Limitations

Single-arm study with no direct comparison to radiotherapy. Small sample (n=72). Bleomycin carries pulmonary risk; current practice often uses EP ×4 for stage IIA to limit pulmonary toxicity. Stage IIB outcomes were modestly inferior to IIA, reflecting nodal burden.

Clinical Context

This Spanish series is a key dataset supporting primary chemotherapy for stage II seminoma, especially IIB. EAU guidelines offer either RT (20 Gy PA ± iliac for IIA; 30 Gy for IIB) or chemotherapy (BEP ×3 or EP ×4), with chemotherapy generally preferred for IIB given superior relapse control over RT in bulky disease.

References