Prognosis of human chorionic gonadotropin-producing seminoma treated by postoperative radiotherapy

Objective: In a prospective multicenter trial, it was our intention to elucidate clinical prognostic factors of seminomas with special reference to the importance of human chorionic gonadotropin (HCG) elevations in histologically pure seminomas. Methods: Together with 96 participating urological departments in Germany, Austria, and Switzerland, we recruited 803 seminoma patients between 1986 and 1991. Out of 726 evaluable cases, 378 had elevated, while 348 had normal HCG values in the cubital vein. Histology was reviewed by two reference pathologists. HCG levels were determined in local laboratories and in a study laboratory. Standard therapy was defined as radiotherapy in stages I (30 Gy) and IIA/B (36 Gy) to the paraaortal and the ispilateral (stage I) and bilateral (stage IIA/B) iliac lymph nodes; higher stages received polychemotherapy and surgery in case of residual tumor masses. Statistics included chi-square tests, linear Cox regression, and log-rank test. Results: The HCG elevation is associated with a larger tumor mass (primary tumor and/or metastases). HCG-positive and HCG-negative seminomas had no different prognostic outcome after standard therapy. The overall relapse rate of 6% and the survival rate of 98% after 36 months (median) indicate an excellent prognosis. The calculation of the relative risk of developing a relapse discovered only stage of the disease and elevation of the lactate dehydrogenase concentration and its prolonged marker decay as independent prognostic factors for seminomas. A more detailed analysis of the prognostic significance of the stage revealed that the high relapse rate in stage IIB seminomas after radiotherapy (24%) is responsible for this result. Conclusions: We conclude that HCG-positive seminomas do not represent a special entity. Provided standard therapy is applied, HCG has no influence on the prognosis. Patients with stage IIB disease should be treated with chemotherapy because of the demonstrated higher relapse rate outside the retroperitoneum.

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“…Our data confirm the results of other authors who found higher stages in seminomas with HCG or LDH elevations [1, 24, 25]. …”

Section: Discussionsupporting

confidence: 83%

“…Nearly all reports were based on small, retrospectively documented series. Only the retrospective analysis of Mirimanoff et al [25]attained 132 HCG-positive cases from ten centers in Switzerland. Schwartz et al [33]reported on 191 stage I seminomas that could be completely reviewed, retrospectively.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

et al. 1999

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“…During the first year of the study, only patients with negative presurgical levels of b-HCG were admitted. During the second and third year of the trial, patients with elevated b-HCG levels of up to 200 IU l À1 were admitted as well, once there was evidence that initial b -HCG elevation did not adversely affect the prognosis of the patients (Mirimanoff et al, 1993). Exclusion criteria were a positive AFP level prior to orchiectomy, a history of prior abdominal/pelvic radiotherapy or chemotherapy, withdrawal of informed consent, concurrent severe diseases, or treatment with cobalt-60 machines.…”

Section: Patient Selection and Staging Processmentioning

confidence: 99%

Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG)

et al. 2004

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A prospective nonrandomised trial was performed in order to evaluate tumour control and toxicity of low-dose adjuvant radiotherapy in stage I seminoma with treatment portals confined to the para-aortic lymph nodes. Between April 1991 and March 1994, 721 patients were enrolled for the trial by 48 centres in Germany. Patients with pure seminoma and no evidence of lymph node involvement or distant metastases received 26 Gy prophylactic limited para-aortic radiotherapy. Disease-free survival at 5 years was the primary end point. With a median follow-up of 61 months, 675 patients with follow-up investigations were evaluable for this analysis. Kaplan -Meier estimates of disease-free and disease-specific survival were 95.8% (95% CI: 94.2 -97.4) and 99.6% (95% CI: 99.2 -100%) at 5 years and 94.9% (95% CI: 92.5 -97.4%) and 99.6% (95% CI: 99.2 -100%) at 8 years, respectively. A total of 26 patients relapsed. All except two were salvaged from relapse. In all, 21 recurrences were located in infradiaphragmatic lymph nodes without any 'in-field' relapse. Nausea and diarrhoea grade 3 were observed in 4.0 and 1.0% of the patients, respectively. Grade 3 late effects have not been observed so far. The results of our trial lend further support to the concept of limited para-aortic irradiation as the recently defined new standard of radiotherapy in stage I seminoma. There is no obvious compromise in disease-specific or disease-free survival compared to more extensive hockey-stick portals, which were used as standard portals at the time this study was initiated.

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“…During the first year of the study, only patients with negative pre-operative levels of ß-hCG were admitted to the study. During the second and third years of the trial, patients with raised ß-hCG levels of up to 200 IU/l were admitted as well since 2 reports have suggested that prognosis is not affected by initial ß-hCG levels (Mirimanoff et al, 1993;Weissbach and BussarMaatz, 1993). Furthermore, no history of prior radiotherapy or chemotherapy or concurrent severe illness was allowed for entry into the study.…”

Section: Patient Selection and Staging Proceduresmentioning

confidence: 99%

Radiotherapy for stages I and IIA/B testicular seminoma

Bamberg

Schmidberger

Meisner³

et al. 1999

Int. J. Cancer

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Prognosis of human chorionic gonadotropin-producing seminoma treated by postoperative radiotherapy

Cited by 26 publications

References 28 publications

Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

Prognostic Factors in Seminomas with Special Respect to HCG: Results of a Prospective Multicenter Study

Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG)

Radiotherapy for stages I and IIA/B testicular seminoma

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