Radiotherapy in Stage IIA and IIB Testicular Seminoma With Reduced Portals: A Prospective Multicenter Study

Schmidberger, Heinz; Bamberg, M.; Meisner, Christoph; Claßen, Johannes; Winkler, Cornelia; Hartmann, Melanie; Templin, Rainer; Wiegel, Thomas; Dornoff, W.; Ross, Dieter; Thiel, Hans-Joachim; Martini, Carmen

doi:10.1016/s0022-5347(01)63315-9

Cited by 14 publications

(17 citation statements)

References 5 publications

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“…No patient experienced severe toxicity regarding a treatment interruption. Our acute toxicity profile is very similar to that in the literature [25,26]. The most common late sequelae of the gastrointestinal tract after adjuvant radiotherapy of earlystage seminoma was reported as peptic ulcer development with a range of 6-16% [27,28].…”

Section: Discussionsupporting

confidence: 78%

Stage I Testicular Seminoma: Para-Aortic and Iliac Irradiation with Reduced Dose after Orchiectomy

Gurkaynak¹,

Akyol²,

Zorlu³

et al. 2003

Urol Int

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Background and Purpose: Radiotherapy remains the treatment of choice for patients with stage I seminoma. The aim of this study is to report preliminary results of reduced dose radiotherapy to ipsilateral pelvic and para-aortic lymph nodes. Materials and Methods: Between February 1996 and December 2001, 53 patients with stage I testicular seminoma were treated with adjuvant radiotherapy after orchiectomy. The median age was 34 years (19–59 years). Four (7.5%) patients had a history of cryptorchidism. Eleven (20.8%) patients showed elevated β-human chorionic gonadotropin. All patients had a radical inguinal orchiectomy and histopathological analysis yielded classic seminoma in 47 (88.7%), spermatocytic in 5 (9.4%) and anaplastic in 1 (1.9%) patients. A total of 19.6–20 Gy in 1.8- to 2-Gy daily fractions was administered to the para-aortic and ipsilateral iliac lymphatics. Results: Median follow-up time was 42 months (12–77 months). One patient developed para-aortic lymph node recurrence at month 28 of the follow-up. Five-year overall and disease-free survivals were 100 and 98%, respectively. Only grade I–II of the Radiation Therapy Oncology Group acute gastrointestinal complications without any severe late toxicity was detected. Conclusion: Reduced dose radiotherapy seems to be as effective as higher doses in the management of stage I seminoma with an acceptable toxicity.

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Section: Discussionsupporting

confidence: 78%

Stage I Testicular Seminoma: Para-Aortic and Iliac Irradiation with Reduced Dose after Orchiectomy

Gurkaynak¹,

Akyol²,

Zorlu³

et al. 2003

Urol Int

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“…There is considerable variability on how stage IIa/b seminomas are treated. The treatment options for stage IIa/b seminomas include, para-aortic and iliac node radiotherapy (Schmidberger et al, 1997;Warde et al, 1998;Classen et al, 2003;Chung et al, 2004), three cycles of BEP (bleomycin, etoposide and cisplatin) or four cycles of EP (etoposide and cisplatin) chemotherapy or a combination of carboplatin chemotherapy and para-aortic radiotherapy (Warde et al, 1998;Arranz Arija et al, 2001;Patterson et al, 2001). All three of the above options provide high rates of cure, but with differing toxicity profiles.…”

Section: Stages Iia/bmentioning

confidence: 99%

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Gilbert

Money-Kyrle

et al. 2008

Br J Cancer

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Testicular germ cell tumours (TGCTs) are the most common cause of cancer in men between the ages of 15 and 40 years, and, overall, the majority of patients should expect to be cured. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma and nonseminomatous germ cell tumours. There is, however, no international consensus on how best to follow patients after their initial management. This must promptly and reliably identify relapses without causing further harm. The standardising of follow-up would result in optimising risk-benefit ratios for individual patients, while ensuring economic use of resources. We have identified the seven common scenarios in managing seminomas and nonseminomas of the various stages and discuss the pertinent issues around relapse and follow-up. We review the available literature and present our comprehensive TGCT follow-up guidelines. Our protocols provide a pragmatic, easily accessible user-friendly basis for other centres to use or to adapt to suit their needs. Furthermore, this should enable future trials to address specific issues around follow-up giving meaningful and useful results. BackgroundTesticular germ cell tumours (TGCTs) are uncommon malignancies but the most common cause of cancer in men between the ages of 15 and 40 years. The peak incidence for nonseminomatous germ cell tumour (NSGCT) is between 20 and 30 years of age, and for seminoma between 30 and 40 years. In the United Kingdom, the incidence rate is only 1 : 100 000 men per year with a lifetime risk of developing a TGCT of 1 in 400 and 1900 new cases per year (Horwich, 2002). There has, however, been a steady increase in the incidence of TGCTs in European countries in the last two decades (Bergstrom et al, 1996). The reasons for this increasing incidence and the aetiology of TGCTs remain unknown. The European Germ Cell Cancer Consensus Group has provided clear guidelines for the primary treatment of both seminoma tumour and NSGCT (Schmoll et al, 2004). There is, however, a lack of clear consensus on how to follow patients after primary treatment, and a number of issues dictate that follow-up should be carefully thought out and rigorously adhered to. Here, we discuss these factors as they pertain to male germ cell tumour (GCT) practice and describe our recently developed protocols. Rational for follow-upDetecting relapse In general, detecting relapse is the major reason for maintaining follow-up and is the main focus of this review. The management of testicular cancer has been a major oncological success story, and provides a model for the management of curative solid tumours (Horwich et al, 2006). The use of platinumbased chemotherapy schedules has resulted in high cure rates for all stages of the disease (International Germ Cell Cancer Collaborative Group, 1997). The fact that the majority of young men treated for testicular cancer have a durable response to primary treatment has resulted in the accumulation of significant data on both the patterns ...

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confidence: 99%

“…With orchiectomy followed by limited irradiation of the draining lymph nodes in the abdomen and pelvis, cure rates of 95% to 98% for stage I disease and 80% to 90% for stage IIA/B seminoma (Royal Marsden classification) can be achieved (Dosmann and Zagars, 1993;Schmidberger et al, 1997;Zagars and Babaian, 1987). In most reported studies, the treatment volume of radiotherapy incorporates the para-aortic and ipsilateral iliac nodes.…”

mentioning

confidence: 99%

Radiotherapy for stages I and IIA/B testicular seminoma

Bamberg

Schmidberger

Meisner³

et al. 1999

Int. J. Cancer

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Radiotherapy in Stage IIA and IIB Testicular Seminoma With Reduced Portals: A Prospective Multicenter Study

Cited by 14 publications

References 5 publications

Stage I Testicular Seminoma: Para-Aortic and Iliac Irradiation with Reduced Dose after Orchiectomy

Stage I Testicular Seminoma: Para-Aortic and Iliac Irradiation with Reduced Dose after Orchiectomy

Evidence-based pragmatic guidelines for the follow-up of testicular cancer: optimising the detection of relapse

Radiotherapy for stages I and IIA/B testicular seminoma

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