What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?

The question is how to manage pathologic confirmed CSII seminoma. If the nodal volume is on the larger side (> 3 or so cm), most experts would treat those patients with BEP X 3 with a very high cure rate, with very low likelihood of requiring any post-chemotherapy interventions.

Most experts in the world strongly favor BEP X 3 over EP X 4 in this setting. I only consider EP X 4 in the rare patients older than 50, those with pre-existing renal disease, or significant co-existing lung disease.

Fo...

We would treat stage IIA with RT alone with 20 Gy in 10 fractions to the PA nodes and ipsilateral pelvis followed by 2x5 Gy boost to involved node with a 3D technique. For IIB, if it is lower volume (closer to 2 cm), we would do same as above, with a boost dose of 2x8. If it is closer to 5cm, then we recommend chemotherapy.

We looked at the NCDB database and the majority of IIA were treated with RT. For IIB, it was close to an even split between RT and chemo. For reasons not fully explainable, w...

I would be interested in the data suggesting BEP x 3 to be preferred to 20Gy of RT with a cone-down boost to 30Gy in this patient population. Not a medical oncologist, but BEP is quite toxic isn't it? Likely more so than 20Gy of radiation with a small area around gross disease getting 30Gy?