Treatment of early stage testicular seminoma.
Stage I and IIA/B testicular seminoma represent approximately 45% of all testicular germ cell tumours. Due to the availability of highly efficient salvage treatment, the disease-specific survival in stage I seminoma is approximately 100%, irrespective of the choice of adjuvant treatment. Radiotherapy with 26 Gy to the paraaortic/paracaval lymph nodes yields excellent cure rates of 95 98% with a favourable profile of acute and late toxicity. Likewise, phase-II trials with single-agent carboplatinum systemic treatment have demonstrated a rate of relapse of 3-4% on average. However, carboplatinum chemotherapy has to be regarded as experimental until data of phase-III trials are available. Surveillance in stage I disease is conflicted with a rate of relapse of approximately 20%. However, 80% of the patients will avoid potentially toxic overtreatment by the watch-and-wait policy. In stage IIA/B seminoma, "dogleg" radiotherapy with 30 Gy and 36 Gy, respectively, provides high cure rates of 90-95%. Those patients relapsing will be salvaged in almost 100% of cases. Testicular intraepithelial neoplasia (TIN) is the common precursor lesion of testicular germ cell tumours except for spermatocytic seminoma. In case of TIN in a single testis or bilateral TIN, local radiotherapy with 18 Gy is recommended as standard treatment.
Classen
J
J
Department of Radiation Oncology, Tübingen University, Germany.
Souchon
R
R
Hehr
T
T
Bamberg
M
M
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D016190:Carboplatin / Q000627:therapeutic use; D002278:Carcinoma in Situ / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011159:Population Surveillance; D018714:Radiotherapy, Adjuvant; D018239:Seminoma / Q000145:classification / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000145:classification / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D016190:Carboplatin