Testicular seminoma. Results of the Yale University experience, 1964–1984

Abstract

Eighty-three testicular seminoma patients were treated with radiation therapy from 1964 through 1984. Seventy-nine (95%) of the 83 patients had early disease that included 61 Stage I, 15 Stage IIA (pelvic or paraaortic lymph node involvement less than or equal to 5 cm), and 3 Stage IIB (pelvic or paraaortic lymph node involvement greater than 5 cm) patients. The 15-year actuarial survival for this group of Stage I and II patients was 95% (+/- 5%). Stage I patients were treated with a mean paraaortic/pelvic dose of 2924 cGy and only one patient developed recurrent disease. This recurrence was at the margin of the radiation field and probably represents a marginal miss. The Stage IIA patients were treated with slightly higher doses (mean, 3335 cGY) to the paraaortic/pelvic region and there were no recurrences. The three Stage IIB patients received tumor doses of 3245 cGy, 4090 cGy, and 4500 cGy, respectively, and there were no recurrences. Low dose prophylactic mediastinal and supraclavicular irradiation (mean, 2320 cGy) was used in 17 (94%) of the 18 Stage II patients and there were no mediastinal or supraclavicular recurrences. Four patients presented with advanced disease (one Stage III, three Stage IV) and the only disease-free survivor was treated with cisplatinum-based combination chemotherapy and radiation therapy. Three patients developed minor complications from the radiation therapy: one patient had persistent scrotal and leg edema and two patients treated with prophylactic mediastinal irradiation had chronic low leukocyte counts. Two of the 79 Stage I and II patients developed a second malignancy: one had bronchogenic carcinoma at the margin of a mediastinal field, and one had diffuse histiocytic lymphoma both in and out of the radiation therapy fields. The 15-year actuarial probability of developing a second malignancy was 3.3%. Radiation therapy after operation is a successful treatment option for most patients with Stage I and II seminoma.

The impact of the ?cisplatin era? of treatment on survival in testicular cancer

“…In the patterns-of-care review, the 10-year survival for seminoma was 91.7%, whereas that for nonseminoma ranged from 60% to 74% [16]. In a recent review of the Yale University experience with seminoma between 1964 and 1984, the 15-year actuarial survival for stage I and II patients was 95% (_+5%) [13]. The 8% cancer mortality obtained in the present study for seminoma patients was equivalent to these reports.…”

Pure seminoma: A review and update

“…This was the standard method until the beginning of the 1980's. Since the 1990's, following the low pelvic relapse rates reported in stage I tumors (less than 5%), the indication for pelvic irradiation was challenged [10,35,36]. The results of this new approach were excellent with a low pelvic relapse rate [37-39].…”

“…We find that a clinical target volume (CTV) on the right side, comprising the paracaval, precaval and inter aortocaval nodes is justified. The left side should comprise, additionally, the latero-aortic, pre-aortic and left renal hilar nodes [6,7,10,35]. The inguinal orchiectomy scar and ipsilateral scrotal contents are not treated unless scrotal violation has occurred during surgery.…”

Recurrent scrotal edema in a patient with radiation enteritis: A case report

“…However, radiation-induced injury remains a major concern, as it may lead to urinary incontinence, erectile dysfunction, radiation enteritis and lymphedema of the lower extremities (5,8). Scrotal edema is a rare side effect of radiotherapy in men with pelvic cancer; Hunter and Peschel were the first to report persistent unilateral scrotal edema as a minor treatment-related complication of radiotherapy in 1989 (9). To date, only few studies have reported the development of scrotal edema in patients who received pelvic radiation; however, they offered no further details on the cases (10-13).…”