Stage I seminoma of the testis: a bi‐institutional retrospective analysis of patients treated with radiation therapy only

Abstract

interviews in men who no longer needed a long-term follow-up. RESULTSThe 10-year overall survival was 97% (98% and 96%, respectively, for the aortic nodes only, or aortic and iliac nodes, i.e. the 'dog leg' field) and disease-free survival was 94%. Twenty-one patients relapsed (five with a true 'in-field' recurrence, nine progressed to the mediastinum, and seven had disseminated disease). Acute toxicity was mainly gastrointestinal, with 7.6% classified as grade II. In all, 73 men achieved paternity after irradiation; nine did not but had normal sperm. Second malignancies were diagnosed in 16 (3.3%) men. CONCLUSIONPara-aortic irradiation may be used safely in patients with stage I seminoma and undisturbed testicular drainage, with equivalent results to the 'dog-leg' group; these unrandomized data confirm the lower toxicity and equivalent survival rates of this treatment.

Canadian consensus guidelines for the management of testicular germ cell cancer

“…In large single or multi-institutional series, the relapse rate has varied from 0.5% to 5% (Table 4). 19,[23][24][25][26][27] The most common sites of relapse following adjuvant radiotherapy are the mediastinum, lungs and the left supraclavicular fossa. A small proportion of patients, usually with predisposing factors, relapse in the inguinal nodes.…”

Pelvic recurrence in stage I seminoma: A new phenomenon that questions modern protocols for radiotherapy and follow‐up

“…also support the exclusion of dogleg irradiation, but acknowledge that 'pelvic recurrences are more frequent after para-aortic radiation and may occur several years after treatment, thus this treatment policy can be recommended only if patients are available for a prolonged follow-up and abdominopelvic CT can be used'. 19 One can suggest that administering a lower dose of irradiation, as in the present patient group, could influence the rate of pelvic relapse. However, using a lower dose should not contribute to a higher incidence of pelvic relapses as these are 'out of field relapses' and thus presumably present as micrometastases at the time of diagnosis of the primary.…”

New Guidelines for Clinical Stage I Testicular Seminoma?

“…[26]. Para-aortic (PA) strip irradiation yields results comparable to those achieved with the ‘dog-leg’ (DL) field, as shown in a randomized study by Fossa et al [6] and in a retrospective study by Santoni et al [27]. The low target volume and decreased radiation dose can reduce the typical radiation-related side effects.…”