Postsurgical policy in stage I testicular seminoma: cost and benefit of prophylactic irradiation in a long-term experience.
The definitive cure rate for clinical stage 1 testicular seminoma is very close to 100%, and prophylactic irradiation of the regional lymph nodes is associated with a low morbidity. Nevertheless, in recent years a "wait-and-see" policy has been proposed by some researchers. We analysed the cost/benefit ratio of radiotherapy (RT) by review of the case histories of 299 patients treated at the Department of Radiotherapy of the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan from January 1968 to December 1989. The 5-year overall survival was 99% (97.5% at 10 years), while the 10-year disease-free survival was 96%. The recurrence rate was 2.3%, but no patient relapsed in the irradiated areas. Acute toxicity was very moderate with only 4 (1.3%) serious radiation sequelae occurring 6 to 27 years after treatment. However, 9 second malignancies (3%) were observed. Lastly, we have calculated the costs for our National Health Service comparing surveillance policy and prophylactic irradiation.
Tana
S
S
Department of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milano, Italy.
Cerrotta
A
A
Gardani
G
G
Palazzi
M
M
Pizzocaro
G
G
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018239:Seminoma / Q000191:economics* / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000191:economics* / Q000517:prevention & control / Q000532:radiotherapy* / Q000601:surgery; D016896:Treatment Outcome