Management of testicular seminoma

Milosevic, Michael; Gospodarowicz, Mary K.; Warde, Padraig

doi:10.1002/(sici)1098-2388(199912)17:4<240::aid-ssu4>3.0.co;2-q

Cited by 21 publications

(11 citation statements)

References 69 publications

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“…However, optimal management of the patients is still a matter of controversy (Milosevic et al, 1999;Classen et al, 2001). In spite of high cure rates achieved with adjuvant radiotherapy, efforts have been made to introduce alternative treatment strategies that would potentially reduce major side effects of irradiation.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…The optimal RT dose is also still a matter of controversy [45]. Generally, the recommended dose is between 25 and 30 Gy in 15 to 20 fractions.…”

Section: Stage I Seminomamentioning

confidence: 99%

Pure seminoma: A review and update

et al. 2011

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Pure seminoma is a rare pathology of the young adult, often discovered in the early stages. Its prognosis is generally excellent and many therapeutic options are available, especially in stage I tumors. High cure rates can be achieved in several ways: standard treatment with radiotherapy is challenged by surveillance and chemotherapy. Toxicity issues and the patients' preferences should be considered when management decisions are made. This paper describes firstly the management of primary seminoma and its nodal involvement and, secondly, the various therapeutic options according to stage.

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“…In infradiafragmatic RT, the field size consists of para‐aortic and ipsilateral iliac lymph nodes, so called ‘dog leg’. But the low incidence of iliac lymph node involvement radiation volume was limited to the para‐aortic lymph nodes alone 10 . In a Norwegian study, 242 standard radiation cases vs 236 para‐aortic radiation alone were conducted.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of 74 cases of seminoma treated with radiotherapy

Güden

Göktaş²,

Sümer³

et al. 2003

Int J of Urology

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Background : Standard post-orchiectomy radiotherapy (RT) is accepted as a standard management option for stage I seminoma. Methods : Retrospective evaluation of 74 patients with stage I seminoma was performed according to the Royal Marsden staging system. All of the patients underwent RT in the Radiation Oncology Department of Gülhane Military Medical Academy between 1974 and 1995. The median age of patients was 27 years (range, 20-56). Radiotherapy was applied to all of the patients after orchiectomy for adjuvant purposes. Sixty-nine patients underwent RT while five patients who had recurrence received chemotherapy following radiotherapy. Results : After a mean follow-up period of 54 months, the 5-year overall survival rate was 98.61%, which complied with the literature. The disease-free survival rate was 90.54%. According to the World Health Organization toxicity scale, acute enteritis was 9.4% for grade I and 5.4% for grade II, while nausea/vomiting was 36.4% for grade I and 5.4% for grade II. Conclusion : To avoid acute toxicity related to RT, prognostic risk factors should be well-known and patients with low risk factors should be monitored carefully after orchiectomy. RT should be directed to the para-aortic ± ipsilateral pelvic lymph nodes in high risk patients. Although post-orchiectomy RT is a traditional management option for clinical stage I seminoma, the results of RT should be well-known to compare it with other treatment options (e.g. RPLND, adjuvant chemotherapy and surveillance).

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Management of testicular seminoma

Cited by 21 publications

References 69 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)

Pure seminoma: A review and update

Retrospective analysis of 74 cases of seminoma treated with radiotherapy

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