Radiotherapy for stages I and IIA/B testicular seminoma

Bamberg, M.; Schmidberger, Heinz; Meisner, Christoph; Claßen, Johannes; Souchon, Rainer; Weinknecht, S.; Schorcht, J; Frank, Werner; Engenhart‐Cabillic, Rita; Schulz, Ulrich; Born, H; Flink, Maria

doi:10.1002/(sici)1097-0215(19991210)83:6<823::aid-ijc22>3.0.co;2-v

Cited by 65 publications

(32 citation statements)

References 25 publications

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“…Interim results of the per protocol population of our trial have been reported previously (Bamberg et al, 1999) lending further evidence to the role of para-aortic radiotherapy as the new standard of radiotherapy in stage I seminoma. We now present an intention-to-treat analysis of the entire study population after a median time to follow-up of 61 months.…”

supporting

confidence: 72%

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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supporting

confidence: 72%

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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“…Gunnlaugsson et al 16 reported a strong correlation between the amount of small bowel irradiated to doses larger than 15 Gy and gastrointestinal side effects. Bamberg et al 17 found acute gastrointestinal side effects more prevalent in irradiated Stage II compared to irradiated Stage I patients that could be attributed to the additional boost or to larger total doses used in the past. It is clear that dose reduction should translate into lower rates of acute and chronic side-effects.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for Stage IIA seminoma: The Northern Israel Oncology Center Experience, 1971–2010

Stein

Zidan

Charas

et al. 2014

Reports of Practical Oncology & Radiotherapy

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“…Several clinical trials have aimed at limitation of dose and extent of adjuvant radiotherapy in stage I disease in order to further reduce the already low incidence of late treatment-related morbidity while leaving the excellent cure rate unchanged [12Á/14]. Special interest has been focused on minimizing the scatter dose to the remaining testis leading to treatment volumes confined to the para-aortic lymph nodes [5,6]. In contrast with the lower field borders the upper border of the para-aortic fields at the T10/T11 level has not been questioned by radiation oncologists so far although the surgical approach Abbreviations: RTI0/rete testis invasion; V 0/vascular invasion; Ln0/lymph node(s); PEI0/cisplatin, etoposide, and ifosfamide; PEB0/ cisplatin, etoposide, and bleomycin; Carbo0/carboplatin; NED0/no evidence of disease.…”

Section: Discussionmentioning

confidence: 99%

“…Simulator x-ray film showing the different target volumes used in this study (A), MRC trial (B) [22], and German trial (C) [6].…”

Section: Follow-upmentioning

confidence: 99%

“…The strategy of all these trials has been to minimize possible treatment-related morbidity while leaving the excellent cure rate unchanged [4]. A British randomized prospective trial of the Medical Research Council (MRC) [5] and a German prospective multicenter trial [6] investigated the limitation of adjuvant RT to para-aortic fields only. The authors found similar survival rates in comparison with portals previously used comprising the para-aortic region and the ipsilateral iliac lymph nodes, described as dog-leg fields.…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant radiotherapy in stage I seminoma: Is there a role for further reduction of treatment volume?

et al. 2005

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An analysis was performed to determine whether a cranial reduction of the portals to the T11/T12 junction instead of the common T10/T11 junction would alter the outcome of patients with stage I seminoma. Of 163 consecutive patients with newly diagnosed testicular seminoma referred to the authors' institution between April 1992 and April 1999, 80 patients with stage I seminoma were treated with cranially reduced para-aortic treatment fields reaching from the top of T12 to the bottom of L4. Median total dose was 20.0 Gy (range, 19.8 Á/27.2 Gy). Patients were followed-up by the use of CT in regular intervals. After a median follow-up of 7.1 years (range, 4.1 Á/11.1 years), four patients (5%) had relapsed resulting in an actuarial 5-year relapse-free survival of 95%. No patients relapsed within the cranially reduced treatment volume above the top of T12. The cranial reduction of the para-aortic treatment fields resulted in a median reduction of treatment volume of 16% (range, 13 Á/21%). The achieved median reduction in treatment volume of 16% appears to be relevant and is not associated with an increased relapse rate. This approach is recommended in analogy to the surgical approach in NSGCT to further minimize the risk of radiation-related late effects.

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Radiotherapy for stages I and IIA/B testicular seminoma

Cited by 65 publications

References 25 publications

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)

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 Stage IIA seminoma: The Northern Israel Oncology Center Experience, 1971–2010

Adjuvant radiotherapy in stage I seminoma: Is there a role for further reduction of treatment volume?

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