title: Management of stage II seminoma.
abstract: OBJECTIVE
  To assess the results of treatment, patterns of failure, and prognostic factors for relapse in a contemporary cohort of patients with stage II seminoma.
  
  
  METHODS
  From January 1981 and December 1993, 99 patients (median age, 35 years) with stage II seminoma (IIA, 41; IIB, 28; IIC, 24; IID, six) were managed at our institution. Eighty were treated with radiation therapy (RT) and 19 with chemotherapy (ChT).
  
  
  RESULTS
  With a median follow-up of 6.7 years, the five-year overall actuarial survival was 94%, the 5-year cause-specific survival was 94%, and the 5-year relapse-free rate was 83%. Sixteen (20%) of the 80 patients treated with RT relapsed (median time to relapse, 9 months). Relapse occurred outside the irradiated area in all but two patients. Distant relapse sites included the supraclavicular fossa, bone (four patients, three with spinal cord compression), and lung/mediastinum. All 19 patients treated primarily with ChT achieved disease control and none has relapsed. The relapse rate at 5 years for patients with stage IIA to IIB was 11% (seven of 64), and 56% (nine of 16) for those with stage IIC to IID disease (P < .0001). No patient with IIC or IID disease treated with ChT relapsed as compared with 56% of patients treated with RT (0 of 14 v nine of 16, P = .002).
  
  
  CONCLUSIONS
  Radiation therapy is highly effective in patients with stage IIA or IIB seminoma (89% were relapse free). In stage IIC or IID disease, although local control with RT is excellent, a 50% risk of distant relapse is unacceptable, and not all patients who relapse can be salvaged. Chemotherapy should clearly be the primary treatment in patients with stage IIC or IID seminoma.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital and the University of Toronto, Canada. padraigvwarde@pmh.toronto.on.ca
authors.forename: P
authors.initials: P
authors.lastname: Warde
authors.forename: M
authors.initials: M
authors.lastname: Gospodarowicz
authors.forename: T
authors.initials: T
authors.lastname: Panzarella
authors.forename: C
authors.initials: C
authors.lastname: Catton
authors.forename: J
authors.initials: J
authors.lastname: Sturgeon
authors.forename: M
authors.initials: M
authors.lastname: Moore
authors.forename: M
authors.initials: M
authors.lastname: Jewett
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001761:Bleomycin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D012186:Retroperitoneal Neoplasms / Q000556:secondary; D012189:Retrospective Studies; D016879:Salvage Therapy; D018239:Seminoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome; D014747:Vinblastine / Q000008:administration & dosage
chemical_list: D001761:Bleomycin; D003609:Dactinomycin; D014747:Vinblastine; D005047:Etoposide; D002945:Cisplatin