Survey of radiation oncologists: practice patterns of the management of stage I seminoma of testis in Canada and a selected group in the United States.
OBJECTIVE
To evaluate practice patterns of the management of stage I seminoma of testis in Canada and a selected group in the United States.


METHODS
Survey among radiation oncologists treating genitourinary (GU) tumors in Canada and the RTOG GU committee members in the United States between January and March 2001.


RESULTS
Response rate was 78% (73/93) in Canada and 67% (24/36) in the United States. Eighty-four percent described their clinical practice as a university affiliated teaching center, and 16% as community-based or private practice. Sixty-two percent, 31% and 7% would manage 1-5, 6-10 and > oe = 11 cases per year respectively. Almost all would perform chest x-ray (99%) and CT scan of abdomen and pelvis (100%) as staging investigation following radical inguinal orchiectomy. Forty percent also arranged CT scan of chest, while only 18% routinely obtained lymphangiogram. Seventy-eight percent offered surveillance as a management option and estimated that 20% (median) of patients would choose surveillance in their practice. Among four management options: (1. surveillance, 2. radiotherapy (RT) to the para-aortic region, 3. RT to the para-aortic and ipsilateral pelvis ('dog-leg'), 4. single-agent chemotherapy), the order of first preference was option 1 (44%), 2 (42%), and 3 (14%) for patients who wish to preserve fertility. When fertility was not a major concern, it was option 2 (43%), 3 (39%), and 1 (17%). The commonest dose-fractionation schedule was 25 Gy/20 fractions (68%). Others included 25 Gy/15 f (15%), and 25.5 Gy/17 f (4%). Forty-five percent chose the para-aortic region, while 53% used the 'dog-leg' as RT volume. Twenty-nine percent reduced RT volume from the 'dog-leg' to the para-aortic region as the result of MRC Phase III study published in 1999.


CONCLUSIONS
There are significant variations in the practice pattern of the management of stage I seminoma of testis among radiation oncologists in Canada and a selected group in the United States.
Choo
Richard
R
Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada.
Sandler
Howard
H
Warde
Padraig
P
Hruby
George
G
DeBoer
Gerrit
G
D002170:Canada; D003625:Data Collection / Q000379:methods; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018787:Radiation Oncology; D018714:Radiotherapy, Adjuvant; D018239:Seminoma / Q000473:pathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*; D014481:United States