Long‐term outcomes following post‐operative radiotherapy for Stage I/II testicular seminoma – an Australasian single‐institution experience

Abstract

IntroductionThe aim of the study is to review the long‐term oncological outcomes and adverse effects of post‐operative radiotherapy (PORT) for Stage I/II seminoma patients in an Australian radiation treatment centre.MethodsThis is a retrospective study of 125 patients with Stage I/II seminoma treated with PORT at the Alfred Health Radiation Oncology Service between 1992 and 2013. Patients were linked to the Victorian Cancer Registry to enable confirmation of survival and diagnosis of secondary malignancies (SM). The relapse‐free survival (RFS), testicular‐cancer‐specific survival (TCSS), overall survival (OS) and SM‐free survival (SMFS) were estimated with Kaplan–Meier methods.ResultsThe median age at diagnosis was 36 (range 20–62). The median time between diagnosis and PORT was 1.6 months (range: 0.5–4.5). Fifty patients (40%) had PORT to the para‐aortic (PA) target alone, while the remaining had PORT to PA and ipsilateral or bilateral iliac lymph nodes. There were no acute adverse effects requiring admission. The median follow‐up after PORT was 7.8 years (range = 0.1–19.1). There were two relapses, both of which occurred within 1 year of PORT (estimated 10‐year RFS = 98.4%). Five deaths were reported, none of which were testicular cancer‐related death (estimated 10‐year TCSS = 100%, 10‐year OS = 97.3%). There were seven SM (one lower lip cancer, one upper shoulder melanoma, one mesothelioma, two prostate cancer, one acute myeloid leukaemia and one contralateral testicular seminoma) reported in six patients, with estimated 10‐year SMFS of 92.9%.ConclusionOur series confirms excellent oncological outcomes among patients with Stage I/II seminoma treated with PORT, with uncommon occurrence of SM.

Systemic therapy and radiotherapy related complications and subsequent hospitalisation rates: a systematic review

“…Subsequently, we selected 80 articles based on eligibility criteria for full-text review. After excluding 55 studies in the full-text review, finally, 25 studies with a total of approximately 33.82 million patients were included in the systematic review [ 7 – 10 , 15 , 18 , 21 , 36 – 53 ]. A total of 55 studies were excluded for various reasons: 12 were editorial, opinion pieces, commentary, or letters to the editor; 9 were review papers; and 34 did not provide sufficient or complete outcome-related data.…”

“…Table 1 shows the characteristics of the included studies in our review. Approximately 52% studies (12 out 25 studies) were in the USA ( n = 13) [ 7 , 9 , 10 , 15 , 18 , 37 , 38 , 40 , 45 , 46 , 49 , 51 , 53 ], followed by 28% studies in Australia ( n = 7) [ 8 , 21 , 36 , 39 , 41 , 42 , 44 ]. In terms of study participants, the selected studies exhibited a wide range, with participant numbers varying from 60 to 29,546,02 participants.…”

“…Systemic therapy includes a range of drug treatments or interventions, including chemotherapy, immunotherapy, and targeted therapy, each precisely tailored to the unique attributes of individual patients, the nature of their diseases, and the predominant treatment objectives [ 11 , 13 , 15 – 18 ]. Several complications occurring from systemic therapy and radiotherapy cover a diverse range [ 7 – 10 ], involving both immediate and long-term effects which have serious repercussions on the quality of life and survival outcomes [ 5 , 19 – 21 ]. These complications are evidenced as haematological toxicities, neurological impairments, gastrointestinal perturbations, dermatological problems, and cardiopulmonary sequelae, among various others [ 9 , 22 , 23 ].…”

Radiotherapy in testicular germ cell tumours – a literature review

“…Long-term observations suggest an increased risk of secondary tumours located in the gastrointestinal tract, bone marrow, the bladder, and the other testicle [ 5 , 6 , 33 , 36 ]. The likelihood of leukaemia also increases because of irradiation of the pelvic bones and the fractionation dose [ 32 , 37 ].…”

“…Determining complications of treatment is an essential part of the therapeutic process and follow-up of patients with GCT. Because of limiting the irradiation field, the currently observed radiation reactions are minor and usually do not require discontinuation of radiotherapy [ 5 ].…”