(UroToday.com) The 2025 ESMO annual meeting featured a testis cancer session and a presentation by Dr. Axel Heidenreich discussing the final results of the COTRIMS (COlogne Trial of Retroperitoneal Lymphadectomy in Metastastic Seminoma) trial. Radiation or chemotherapy represent the standard treatment in clinical stage IIA/B seminoma. Despite high cure rates, both modalities are associated with significant long-term toxicities. The COTRIMS trial evaluated the oncological and functional efficacy of primary retroperitoneal lymphadenectomy (RPLND) without adjuvant chemotherapy in CS IIA/B seminomas.1
There were 34 patients with CS IIA/B pure seminoma prospectively recruited. Exclusion criteria were adjuvant chemotherapy following orchiectomy, CS IIC, previous retroperitoneal surgery or radiation, positive tumor markers. All patients underwent nerve sparing RPLND with a unilateral template and no adjuvant chemotherapy was delivered:
Follow-up was done according to EAU guidelines. In 27 patients mIR-371 was evaluated preoperatively and correlated with pathohistology of lymph nodes.
The median age was 34.2 (IQR 21-65) years, and the median follow-up was 54.2 (IQR 24-70) months:
Overall, 22 and 12 patients had CS IIA and CS IIB, respectively. The mean OR time was 131 minutes (range: 105-195), mean blood loss was <150 mL (range: 50-290), and mean hospitalization was 4.5 days (range: 3-9) days. There were 4 (11.8%) patients that experienced a Clavien Dindo 3A complication, and antegrade ejaculation was preserved in 88% of patients. A mean of 19 (range: 7-57) lymph nodes were dissected, the mean number of positive lymph nodes was 1.4 (range: 1-2), and the mean diameter was 2.3 (range: 0.8-4.1) cm. Seminoma was present in 88% of specimens. Overall, 4 (11.7%) patients relapsed after 4, 6, 9 and 12 months and all were salvaged by chemotherapy (n = 3) or re-do RPLND (n = 1). mIR-371 was measured in 24/27 patients, with 23/24 (95.8%) correct positive and 3/3 (100%) correct negative:
Dr. Heidenreich concluded his presentation discussing final results of the COTRIMS trial with the following take home points:
- RPLND results in high cure rates associated with low frequency of surgery related complication even after a follow-up of about 3 years
- Nearly 90% of patients can be managed without systemic chemotherapy
- RPLND should be included in the treatment options for CS IIA/B seminomas
- mIR-371 appears to be a valid biomarker to predict presence of lymph node metastases
- A summary of the results of current trials is noted in the following table:
Presented by: Axel Heidenreich, MD, PhD, Professor, Department of Urology, University of Cologne, Cologne, Germany
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2025 European Society of Medical Oncology (ESMO) Annual Meeting, Berlin, Germany, Fri, Oct 17 – Tues, Oct 21, 2025.
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