Axel Heidenreich, MD, University Hospital of Cologne, Cologne, Germany, discusses final results from the COTRIMS trial presented at the 2025 American Society for Clinical Oncology (ASCO) Genitourinary Cancers Symposium. These data found that primary retroperitoneal lymphadenectomy demonstrated long-term efficacy among patients with metastatic seminomas. 

Dr Heidenreich concluded, “Nerve-sparing retroperitoneal lymphadenectomy should be the treatment of choice in patients either with clinical stage 2A or small volume clinical stage 2B.”

Transcript: 

Good afternoon, my name is Professor Axel Heidenreich. I'm the director and chairman of the Department of Urology of the University Hospital in Cologne, Germany, and it is my pleasure to present to you our data on a prospective clinical trial of nerve-sparing retroperitoneal lymphadenectomy in patients with clinical stage 2A/B seminomas. 

As you all know, standard treatment for those patients is either chemotherapy with 3 or 4 cycles PEB [cisplatin, etoposide, and bleomycin] or EP [etoposide and cisplatin] or it could be radiation treatments to the retroperitoneum. Although both of these treatment options are associated with a high-cure rate of about 95%, there is a significant excess long-term mortality due to non-cancer induced secondary malignancies or cardiovascular disease and this is why we thought to perform a prospective trial with locoregional surgery to remove all metastatic deficits in order to avoid systemic chemotherapy or radiation treatment in those patients.

It was a prospective trial, only patients with pure seminoma and marker-negative seminomas were allowed to enter the trial. None of the patients was allowed to have received adjuvant chemotherapy following orchiectomy. All of those patients either had clinical stage 2A or a small volume clinical stage 2B disease and they underwent open retroperitoneal lymphadenectomy in a modified unilateral template. Whenever possible, nerve-sparing surgery was performed. A total of 34 patients were included in this trial, our median follow-up is 43 months, about 4 years, which is sufficient time to draw significant clinical conclusions from our trial. We did identify seminoma in those enlarged retroperitoneal lymph nodes. In 85% of our patients, 10% had embryonal carcinoma and the rest of the patients had non-malignant lymphadenopathy. 

Surgery was performed without significant treatment associated complications, only about 10% of the patients had Clavian-Dindo classification side effects of the value of 3A. Antegrade ejaculation could be preserved in 90% of the patients. Only 4 out of 34 patients, which is 11% of the patients, did develop a relapsing disease and all of those patients were cured with salvage chemotherapy. 

Beside our trial, we have 4 other prospective and retrospective trials, and we have a total series of 234 patients. All of those trials demonstrate a low relapse rate of about 5% to 15%. The majority of patients can be cured by surgery alone. This type of surgery has been included in the AOA guidelines, in the NCCN guidelines, and in the ENOTECA guidelines and based on the results of our study and the results of the other studies, we conclude that nerve-sparing retroperitoneal lymphadenectomy should be the treatment of choice in patients either with clinical stage 2A or small volume clinical stage 2B, if this type of surgery is performed in highly experienced centers by highly experienced surgeons.

Source: 

Heidenreich A, Pfister D, Paffenholz P, et al. Prospective COTRIMS (Cologne trial of retroperitoneal lymphadectomy in metastatic seminoma) trial: Final results. Presented at 2025 ASCO Genitourinary Cancers Symposium. February 13-15, 2025; San Francisco, CA. Abstract 618