No statistically significant differences in treatment efficacy were detected between 20 Gy IF radiotherapy and 1X (COPP + ABVD) chemotherapy following CR after six cycles of alternating chemotherapy in patients with advanced-stage HD. However, limited observations in a non-randomized cohort indicate that patients without consolidation treatment of CR after 6 cycles of chemotherapy may have an elevated risk of relapse.

Possible protective effects of D-Tryptophan-6 luteinizing hormone releasing hormone (D-Trp-6-LH-RH) against irradiation-induced testicular damage were investigated for the first time in patients with seminoma. After unilateral orchiectomy 12 men were allocated to receive the long-acting gonadotropin releasing hormone (GnRH) agonist D-Trp-6-LH-RH prior to and for the duration of radiotherapy. Eight patients with the same disease served as a control group. In contrast to several trials to protect spermatogenesis from chemotherapy by GnRH agonists, we first suppressed the pituitary-testicular axis before starting the treatment. As a new schedule this adjuvant GnRH agonist treatment was combined with cyproterone acetate for the first 20 days to diminish the amount and the duration of the initial stimulation of gonadotropins and testosterone. Irradiation started after suppression of the pituitary-gonadal axis. In all patients luteinizing hormone and testosterone were completely suppressed throughout the treatment compared to the controls, whereas the initial suppression of follicle-stimulating hormone was not completely maintained until radiotherapy was completed. At the follow-up at 18 months after completion of therapy, all patients reached their initial concentration of gonadotropins, testosterone, and motile spermatozoa independently of D-Trp-6-LH-RH treatment. With the dose and schedule investigated, the GnRH agonist showed no protective effects against testicular damage caused by radiotherapy.

No abstract

Lymphography and computer tomography was performed on 64 patients with malignant testicular tumours in order to demonstrate lymph node metastases. In 60 patients it was possible to confirm the findings by surgery. In 43 patients there was agreement between the findings of the computer tomogram and the lymphogram. In 39 of these patients lymph node metastases had been demonstrated, in three there was a false negative and in one a false positive. Amongst the patients in whom there was a descrepancy between the two types of examination, the CT findings were confirmed histologically in twelve, and the lymphographic findings in nine. In 12.5% CT added significant additional information. Accuracy of lymphography was 73% and of computer tomography 80%. Specificity for each examination was 79%.

As radiotherapy may lead to a significant increase in breast volume, it seems appropriate to perform a second planning CT after about 40 Gy in order to optimize dose distribution for boost irradiation.