What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?

Para-aortic nodal disease <5 cm is well treated with radiotherapy to PA+pelvis with boost tot eh nodes with high cure rates and minimal toxicity. >5cm best treated with BEP or EP chemotherapy. No role for RPLND in seminoma.

The challenge in small volume stage II seminoma is the same as in non-seminoma but likely worse. We know that in marker negative small volume stage II non-seminoma that the false positive rate of clinical assessments (primarily CT) can be up to 40%. If therapy, either radiation or chemotherapy, is i...

Agree, however, we can't over-interpret the SEMS trial (very small sample size; n= 55). I do favor CDDP-based chemotherapy to most patients with IIB (LNs>2 and <5cm).