Relapses in Early-stage Testicular Seminoma: Radiation Therapy versus Retroperitoneal Lymphadenectomy

Abstract

Being among the most radiosensitive tumours, radiation therapy has replaced retroperitoneal lymphadenectomy in the treatment of early-stage testicular seminoma. One hundred and sixty-one patients who were treated from 1975 through to 1991 with histologically confirmed testicular seminoma of stages I and II were analyses retrospectively. After high semicastration, 98 patients were treated by radiation therapy of regional lymph nodes and 63 patients received retroperitoneal lymphadenectomy. Until 1985 retroperitoneal lymphadenectomy was preferred, but after 1985 radiotherapy outweighed retroperitoneal lymphadenectomy. The follow-up ranged from 11 months to 13.5 years, with a median of 79 months. Retroperitoneally, in-field relapses occurred in 9.5% (6/63 patients) after retroperitoneal lymphadenectomy and in 2.0% (2/98 patients) after radiation therapy (Fisher exact test, p = 0.057). A trend to a higher frequency of retroperitoneal relapses after retroperitoneal lymphadenectomy seemed to be apparent. Relapses outside the operation site or radiation fields were registered with non-significantly different frequencies (p = 0.741) of 4.8% (3/63 patients) and 7.1% (7/98 patients), respectively. Relapses increased from 4.1% for stage I (5/121 patients) up to 58.3% for stage IIC (7/12 patients).

Retroperitoneal lymph node dissection for high-risk stage I and stage IIA seminoma

“…The data concerning RPLND for these purposes are very limited. The only report has compared the results of radiotherapy (98 patients) and RPLND (63 patients) in seminoma patients [31]. The authors claim that radiotherapy is more effective since it is associated with a less number of recurrences in the treated field.…”

Classification, epidemiology and therapies for testicular germ cell tumours

“…prospective, non-randomised study comparing radiotherapy and RPLND in stage I seminoma, there was a trend towards a higher incidence of retroperitoneal relapses (9.5%) after RPLND as primary treatment (Warszawski et al, 1997).…”

Retroperitoneal Lymph Node Dissection as First-Line Treatment of Node-Positive Seminoma

“…Adjuvant CT was considered for all patients, in particular, for those with more advanced nodal disease (patients 3 and 4), given the previously cited relapse rates in those with stage IIB/IIC disease of > 50%. 17 Ultimately, these patients elected to undergo expectant treatment and were free of relapse during the follow-up period.…”

“…17,18 The first study was an institutional review from the University Hospital of Magdeburg (Magdeburg, Germany), where RPLND was used for stage I and II seminoma. 17 Surgery was the preferred management at their institution until 1985. Seven patients had undergone primary RPLND for stage IIA disease, and none had developed a relapse at a median follow-up period of 6.6 years.…”