How would you treat a stage IIIB recurrent seminoma with early recurrence following first-line treatment with VIP?

If one is faced with recurrent stage IIIB seminoma, I recommend the following:

• Confirm the diagnosis and prior Rx - review initial pathology, staging, and dose/ intensity of Rx. Sometimes, another clinician has treated the wrong entity - where review shows that it was initially a nonseminomatous germ cell tumor or a large cell lymphoma.
• Check AFP and HCG - may suggest that it is now NSGCT. Remember low and moderate elevation of HCG alone can be consistent with relapsed seminoma. If markers are ...

I have several comments. The great majority of patients with pure seminoma requiring chemo are good risk disease and therefore, are successfully treated with either BEP x 3 or EP x 4. There are no patients with seminoma with poor risk disease. If he had non-pulmonary visceral disease, he would have been intermediate risk and treated with BEP x 4 unless a contraindication to bleo and then treated with VIP. It sounds like this patient relapsed shortly after completion of VIP. Neither TIP nor VeIP ...