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  • RPLND or direct to Chemo


    Just diagnosed and presented with the dilemma that others seem to face. I have a stage IIb embryonic carcinoma with a single lymph node CT finding of 1.5cm x 2.2cm . No elevated markers in blood. I am 43 years old and have good physical fitness.

    I was presented with the option of doing RPLND (which I would do at a large center) with the possibility of follow-up chemo or just going straight to chemo. My urologist said he would go direct to chemo since its been shown to be highly successfully with embryonic cancers. I am getting a second opinion from an medical oncologist at a Dana Farber on Friday. I have been advised to move quickly on making a decision.

    How have others in a similar situation tackled this decision? Is there a center/ physician that is especially good at helping folks make the surgery v. chemo call.


  • #2
    Hello Fredmeyer,

    Yes, I faced a similar situation. Pure embryonal carcinoma, slightly elevated LDH and 3 suspiciously enlarged lymph nodes. I visited with my local surgeon and Oncologist to review RPLND vs 3 x BEP. As my surgeon put it, with RPLND first, there’s a higher likelihood of still doing chemo later vs. doing chemo first and maybe RPLND after. That is due to the nature of how embryonal carcinoma can travel throughout the body.

    I opted for 3 x BEP given its high level of effectiveness on EC and once I completed the treatment, I visited with Dr. Einhorn at Indiana University to review my case in full. He stated that the BEP was effective and no need for RPLND.

    I hope that helps.

    Best of luck, tough few months ahead but you’ll make it through the other side. Keep us posted!


    • #3
      Personally, I would lead with the chemo, others here might feel otherwise
      Jan, 1975: Right I/O, followed by RPLND
      Dec, 2009: Left I/O, followed by 3xBEP


      • #4
        I was presented with similar situation 4 years ago. Embryonal, stage 2b, couple of lymph nodes 2cm. There was talk of rplnd before chemo but because markers didn't go down 4 weeks after orchiectomy the decision was no longer mine and chemo it was. Still ended up having rplnd as tumours hadn't shrunk to the magic 1cm. From what i've been told removing nodes is a lot easier before chemo but then it might not be necessary after chemo. It may also be good to clean up any micrometastases that might be lurking with chemo too. Maybe the numbers will decide for you. Either way I hope you are able to get away with just one procedure. Good luck with whatever you end up doing.


        • #5
          How was the appointment at Dana Farber? Did you meet with Dr. Chris Sweeney?

          There is a big difference between RPLND for a single node vs. multiple nodes so that is why some here would have favored BEPx3, I believe. With a solitary node, normal tumor markers and no other symptoms, then that is a best case for the use of RPLND and would confirm that pathology in the abdomen. However, BEPx3 is also just as appropriate and perhaps more so if there isn't an experienced RPLND surgeon. Are you able to get into Dana Farber for the RPLND? The surgeon would really play a role in my thinking in this situation.

          Oct. 2005 felt lump but waited over 7 months.
          06.15.06 "You have Cancer"
          06.26.06 Left I/O
          06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
          06.30.06 It's Official - Stage I Seminoma
          Founded the Testicular Cancer Society
          6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

          For some reason I do not get notices of private messages on here so please feel free to email me directly at if you would like to chat privately so as to avoid any delays.


          • #6
            Hi All,

            Thanks for the input. I decided on going direct to 3xBEP following the recommendation of Sweeney and others at DFCI and my local provider. I also had a phone chat with MSK (Sheinfeld) and he was more neutral on what direction to head.