Radiotherapy after testis-sparing surgery for seminoma in monorchid patients: safety and efficacy

Abstract

Purpose: To evaluate local control and longitudinal endocrine data in monorchid patients treated with testicular-sparing surgery and adjuvant radiotherapy (RT) for seminomatous germ-cell tumors. Methods: We searched our database established in 2009 for patients with seminoma who received testis irradiation following partial orchiectomy up to 2018. Eleven patients were identified. All had associated germ cell neoplasia in situ (GCNIS) in surrounding parenchyma. Analysis focused on local control and testosterone levels preservation after RT. We considered age, baseline (pre-RT) testosterone and luteinizing hormone (LH) levels, residual testicular volume, tumor size, and testosterone and LH levels trend over time in order to identify any association with endocrine impairment leading to hormonal replacement need. Results: After a median follow-up of 21 months, no local or distant relapses were observed and hormonal function was maintained in 54.5% of patients (6/11). No significant interactions were observed for the investigated covariates. Notably, we observed an association between higher baseline testosterone levels and a decreased risk of exogenous androgen replacement (hazard ratio [HR] 0.409, 95% confidence interval [CI] 0.161–1.039, p = 0.060), whereas tumor size was associated with an increased risk of exogenous androgen replacement (HR 1.847, 95% CI 0.940–3.627, p = 0.075). Conclusions: Radiotherapy after testicular sparing surgery is effective in preventing local disease relapse in presence of GCNIS in the medium term. This strategy allows a preservation of adequate endocrine function in about half of patients. More patients and longer follow-up are needed to confirm these findings.

Organ-Sparing Surgery for Testicular Germ Cell Tumors: A Current Perspective

“…The presence of GCNIS in a testis carries an estimated risk of evolving into invasive disease of 50% within 5 years and 70% within 7 years [ 44 ]. Therefore, it is necessary to consider local radiotherapy for patients with GCNIS, particularly for those with a solitary testis [ 45 , 46 , 47 ]. In Avuzzi et al’s study, radiotherapy following testicular-sparing surgery showed no local or distant relapses in a medium-term follow-up, with hormonal function preserved in about 54.5% of patients.…”

“…In Avuzzi et al’s study, radiotherapy following testicular-sparing surgery showed no local or distant relapses in a medium-term follow-up, with hormonal function preserved in about 54.5% of patients. Associations were noted between baseline testosterone levels, tumor size, and risk of exogenous androgen replacement [ 46 ]. Dieckmann et al highlight that 18–20 Gy local radiotherapy eradicates the majority of GCNIS.…”