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

Gurkaynak, M.; Akyol, Fadıl; Zorlu, Faruk; Akyürek, Serap; Yıldız, Ferah; Atahan, I. Lale

doi:10.1159/000074091

Cited by 12 publications

(4 citation statements)

References 37 publications

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“…This study compared 20 Gy in 10 fractions to 30 Gy in 15 fractions to the paraaortic lymph nodes alone and showed equivalent relapse rates in both arms with a median follow-up of 61 months. Radiation doses of less than 20 Gy have been associated with in-field failures reported in the literature [13][14][15]. A hypofractionated approach using 20 Gy in 8 fractions over 1.5 weeks has been advocated by Logue et al [9] from the Christie Hospital in Manchester.…”

Section: Radiation Dosementioning

confidence: 99%

Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma

2006

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Treatment options in patients with stage I seminoma include radiotherapy (RT), surveillance, and adjuvant chemotherapy. This patient population has virtually a 100% cure rate whichever approach is taken. While adjuvant retroperitoneal RT has been the standard of care for the past 50-60 years, there is increasingly persuasive data that adjuvant RT in this setting is associated with a small but definite increased risk of second malignancy and cardiovascular death. The long-term data from surveillance series have documented the safety of this approach, and it is now accepted that a policy of surveillance is the optimal management approach. This gives a relapse rate of 15%, and most patients can be successfully salvaged with RT. Second relapse after salvage RT occurs in a small proportion of cases, and these patients are cured with chemotherapy. Adjuvant chemotherapy using carboplatin has been investigated as an alternative strategy but has not lived up to its initial promise. If used, then 2 courses of treatment should probably be given. It must be remembered that 80-85% of patients with testicular seminoma require no treatment after orchiectomy, and the long-term side effects of any adjuvant treatment approach must be carefully considered.

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Section: Radiation Dosementioning

confidence: 99%

Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma

2006

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“…As a safeguard against pelvic recurrence, radiation to the para‐aortic and the ipsilateral iliac nodes was the initial standard using a pair of parallel–opposed anteroposterior–posteroanterior ‘dog‐leg’ fields 3 . This technique is associated with long‐term relapse‐free survivals in excess of 95% 4,7,8 . Thus, seminomas diagnosed and treated at an early stage are eminently curable.…”

Section: Discussionmentioning

confidence: 99%

Stage I seminoma in a 15‐year‐old boy

Geake

Potter

Borg

et al. 2007

Australasian Radiology

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Seminomas are very rare tumours in children and adolescents. We describe a case of seminoma in a 15-year-old boy who was managed with orchidectomy but no adjuvant therapy. He remains relapse-free 8 years after surgery as determined by clinical, radiological and serological surveillance. This study emphasizes the uncertainty over the need for adjuvant treatment in the management of seminoma in the adolescent patient, in particular in prepubescent children.

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“…Data from MRC TE18 trial comparing 20 Gy in 10 fractions to 30 Gy in 15 fractions to the paraaortic lymph nodes alone shows equivalent relapse rates in both arms with a median follow‐up of 61 months 34 . However, in a single institution study of 53 patients treated with 20 Gy in 10 fractions to the paraaortic and iliac lymph nodes, one patient (of an expected eight with micrometastatic nodal disease based on surveillance data) relapsed in‐field 45 . Further follow‐up is necessary before this schedule can be adopted.…”

Section: Adjuvant Radiotherapymentioning

confidence: 99%

“…34 However, in a single institution study of 53 patients treated with 20 Gy in 10 fractions to the paraaortic and iliac lymph nodes, one patient (of an expected eight with micrometastatic nodal disease based on surveillance data) relapsed in-field. 45 Further follow-up is necessary before this schedule can be adopted.…”

Section: Radiation Dose/technique/treatment Volumementioning

confidence: 99%

Stage I seminoma: What should a practicing uro‐oncologist do in 2009?

Skliarenko¹,

Vesprini²,

Warde³

2009

Int J of Urology

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Testicular tumors are uncommon, but they continue to represent an important group of malignancies in young men. It is the most common solid malignancy in males between the ages of 20 and 35, and primary germ cell tumors are the most common histological type. In the United States in 2008, approximately 4800 cases of seminoma, approximately 4100 of which were stage I disease were projected after the completion of staging investigations.Remarkable progress has been made in the treatment of testicular seminoma over the past 25 years. Management options of stage I seminoma include radiotherapy, surveillance, or adjuvant chemotherapy. Standard management until recent years has been adjuvant retroperitoneal radiotherapy. Although providing excellent long term results, this approach has been associated with increased risk of gonadal toxicity, development of secondary malignancies and an increased risk of cardiovascular disease. The use of surveillance in management of patients with stage I seminoma is therefore becoming more frequent as it minimizes the burden of treatment and maintains the cure rate at virtually 100%. Adjuvant chemotherapy using Carboplatin has been investigated as an alternative management approach. However, the long term outcomes of patients managed with Carboplatin are not yet clear and this strategy should only be used in a study setting. It has been suggested that more patients with stage I seminoma will die of their treatment than of their cancer; therefore, the thrust of modern management should be to maintain 100% cure while minimizing the burden of treatment.

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

Cited by 12 publications

References 37 publications

Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma

Treatment Options, Prognostic Factors and Selection of Treatment in Stage I Seminoma

Stage I seminoma in a 15‐year‐old boy

Stage I seminoma: What should a practicing uro‐oncologist do in 2009?

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