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

Abstract

Objective : To highlight the increased risk for pelvic relapse in patients with stage 1 seminoma treated with adjuvant radiotherapy limited to para-aortic template alone. Patients and methods : Over a four-year period, three patients presented with early pelvic recurrence after radical orchidectomy and adjuvant irradiation for stage 1 seminoma. In each case, radiotherapy had been limited to the para-aortic region with omission of the ipsilateral hemi pelvis.Results : Pelvic recurrences occurred on the ipsilateral tumor side. Durable complete remission was achieved in each case; however, treatment was complex and there was associated morbidity. Conclusion : This significant incidence of pelvic recurrence questions the validity of modern radiotherapy protocol which excludes the ipsilateral pelvis from the radiation field.

Pure seminoma: A review and update

“…The reduced volume permits limiting the area, preserving the remaining testicular function and will hopefully decrease the secondary cancer rate [40,41]. However this strategy is still debated [42] in spite of the very well conducted randomized study by the Medical Research Council (MRC) Testicular Cancer Working Party. In this trial 478 patients were randomized between para-aortic and pelvic RT versus para-aortic RT alone.…”

Late recurrence of Seminoma in the pelvis: A case report

“… 2 Management most often involves orchidectomy with adjuvant radiotherapy, yielding excellent results with 5-year survival rates as high as 98%. 3 Studies have noted early relapse rates for stage I seminoma with adjuvant radiation or chemotherapy to be approximately 15–19% by 15 months. 4 …”

“… 4 Of patients that present with stage I seminoma, 15% are thought to already have micrometastases to regional lymph nodes. 3 These relapse rates warrant lifetime active surveillance with CT, especially within the first few years after initial treatment. Benefits and risks of active surveillance, such as radiation exposure and financial status of the patient should be taken into account.…”

“… 1 , 2 While recurrences of seminoma are rare due to impressive results from adjuvant therapies, recurrences can occur in areas outside the landing zones that are not consistent with the typical patterns of spread. 3 In stage 1 pure seminoma, late relapse rates post-orchiectomy and adjuvant radiotherapy are approximately 3%, mainly occurring in the mediastinum and/or pelvis. 2 , 4 We present a case of a 73-year-old male with late recurrence of pure seminoma in an atypical landing zone in the contralateral iliac fossa thirty years after initial treatment with radical orchiectomy and adjuvant external beam radiation therapy.…”

Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

“…Although the para-aortic field has emanated as the standard radiation approach in seminoma patients [15], Power et al [16] reported the occurrence of ipsilateral pelvic relapse in 3 patients that would otherwise have been avoided if the radiation field was extended. In our case series, one out of the 3 patients who developed relapse harbored regional disease.…”