Seminoma arising in corrected and uncorrected inguinal cryptorchidism: Treatment and prognosis in 66 patients

Abstract

Purpose: The purpose of this study was to analyze prognosis and treatment results for seminoma arising in corrected and uncorrected inguinal cryptorchidism (SCIC and SUIC). Methods and Materials: We reviewed 66 patients with inguinal seminomas between June 1958 and December 1991 at the Cancer Hospital and Institute of Chinese Academy of Medical Sciences. Of these patients, 23 had prior orchiopexy and 43 presented with an inguinal form of cryptorchidism. At presentation, 17 of 66 (26%) patients had nodal metastases. This nodal involvement was 30% (7 of 23) for SCIC and 23% (10 of 43) for SUIC, respectively. These numbers are comparable with those in a series of patients treated for scrotal seminoma at our institution (26% vs. 20%). However, 3 of 23 (13%) patients who had prior orchiopexy presented with inguinal nodal metastasis as compared with 0 of 43 patients with SUIC or 4 of 237 patients with scrotal seminoma (p < .05). There were 49 stage I, 5 stage IIA, 8 stage IIB, 3 stage III, and 1 stage IV patients. All patients underwent radical orchiectomy and received further radiotherapy, chemotherapy, or both. Patients with stage I and stage II disease were treated primarily with radiotherapy, whereas patients with stage III and IV disease were treated with chemotherapy. Results: The overall and disease-free survival at 5 and 10 years was 94% and 92%, 89% and 87%, respectively. The overall 5-and lo-year survival by stage was 100% and 100% for stage I, and 77% and 68% for stage II, respectively @ < .05). There was no significant difference in survival between SUIC and SCIC (93% vs. 96% at 5 years). Four patients developed relapse. Two of these four patients experienced relapse at the inguinal area, due to a marginal miss. Three of four patients with relapse were successfully salvaged, and one died of disease. Conclusion: Our results indicate that prognosis for inguinal seminoma is excellent and similar to that of scrotal seminoma. Postorchiectomy radiotherapy can be considered as the standard treatment for stage I and IIA inguinal seminoma. We recommend routinely including the para-aortic and ipsilateral pelvic nodes. 0 1997 Elsevier Science Inc. Seminoma, Cryptorchidism, Radiotherapy.

Is Radiotherapy a Good Adjuvant Strategy for Men With a History of Cryptorchism and Stage I Seminoma?

“…Although one series has suggested whole pelvic RT for men with a pelvic cryptorchid testis and Stage I seminoma (4), our data would suggest that dog-leg RT alone would be adequate. This is in agreement with findings from other institutions (13).…”

“…Furthermore, ensuring modern staging should help to ensure that the cohort was indeed men with true Stage I seminoma. Some series have compared the outcomes of men with a history of cryptorchidism that had been corrected vs. those with uncorrected cryptorchidism (9,13). The main difference with the latter group appears to be that they can present with more advanced disease but that otherwise the outcomes are similar stage for stage compared with the noncryptorchid population.…”

“…Of the 23 men, 18 underwent adjuvant RT to a median dose of 25 Gy (range, 20-30) in 15 fractions (range, [10][11][12][13][14][15][16][17][18][19][20]. All included the para-aortic region, 12 included ipsilateral common iliac, 5 the ipsilateral external iliac, and 2 the ipsilateral inguinal lymph nodes.…”