Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group.
OBJECTIVE
To compare relapse rates and toxicity associated with para-aortic (PA) strip or PA and ipsilateral iliac lymph node irradiation (dogleg [DL] field) (30 Gy/15 fractions/3 weeks) for stage I testicular seminoma.


METHODS
Between July 1989 and May 1993, 478 men with testicular seminoma stage I (T1 to T3; no ipsilateral inguinoscrotal operation before orchiectomy) were randomized (PA, 236 patients; DL, 242 patients).


RESULTS
Median follow-up time is 4.5 years. Eighteen relapses, nine in each treatment group, have occurred 4 to 35 months after radiotherapy; among these, four were pelvic relapses, all occurring after PA radiotherapy. However, the 95% confidence interval (CI) for the difference in pelvic relapse rates excludes differences of more than 4%. The 3-year relapse-free survival was 96% (95% CI, 94% to 99%) after PA radiotherapy and 96.6% (95% CI, 94% to 99%) after DL (difference, 0.6%; 95% confidence limits, -3.4%, +4.6%). One patient (PA field) has died from seminoma. Survival at 3 years was 99.3% for PA and 100% for DL radiotherapy. Acute toxicity (nausea, vomiting, leukopenia) was less frequent and less pronounced in patients in the PA arm. Within the first 18 months of follow-up, the sperm counts were significantly higher after PA than after DL irradiation.


CONCLUSIONS
In patients with testicular seminoma stage I (T1 to T3) and with undisturbed lymphatic drainage, adjuvant radiotherapy confined to the PA lymph nodes is associated with reduced hematologic, gastrointestinal, and gonadal toxicity, but with a higher risk of pelvic recurrence, compared with DL radiotherapy. The recurrence rate is low with either treatment. PA radiotherapy is recommended as standard treatment in these patients.
Fosså
S D
SD
Norwegian Radium Hospital, Oslo, Norway. s.d.fossa@klinmed.u10.no
Horwich
A
A
Russell
J M
JM
Roberts
J T
JT
Cullen
M H
MH
Hodson
N J
NJ
Jones
W G
WG
Yosef
H
H
Duchesne
G M
GM
Owen
J R
JR
Grosch
E J
EJ
Chetiyawardana
A D
AD
Reed
N S
NS
Widmer
B
B
Stenning
S P
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010437:Peptic Ulcer / Q000209:etiology; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016879:Salvage Therapy; D018239:Seminoma / Q000401:mortality / Q000532:radiotherapy*; D013091:Spermatogenesis / Q000528:radiation effects; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality / Q000532:radiotherapy*