title: Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group.
abstract: 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.
authors.affiliation: Norwegian Radium Hospital, Oslo, Norway. s.d.fossa@klinmed.u10.no
authors.forename: S D
authors.initials: SD
authors.lastname: Fosså
authors.forename: A
authors.initials: A
authors.lastname: Horwich
authors.forename: J M
authors.initials: JM
authors.lastname: Russell
authors.forename: J T
authors.initials: JT
authors.lastname: Roberts
authors.forename: M H
authors.initials: MH
authors.lastname: Cullen
authors.forename: N J
authors.initials: NJ
authors.lastname: Hodson
authors.forename: W G
authors.initials: WG
authors.lastname: Jones
authors.forename: H
authors.initials: H
authors.lastname: Yosef
authors.forename: G M
authors.initials: GM
authors.lastname: Duchesne
authors.forename: J R
authors.initials: JR
authors.lastname: Owen
authors.forename: E J
authors.initials: EJ
authors.lastname: Grosch
authors.forename: A D
authors.initials: AD
authors.lastname: Chetiyawardana
authors.forename: N S
authors.initials: NS
authors.lastname: Reed
authors.forename: B
authors.initials: B
authors.lastname: Widmer
authors.forename: S P
authors.initials: SP
authors.lastname: Stenning
mesh_terms: 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*