title: Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial.
abstract: OBJECTIVE
  A prospective multicenter trial was initiated to evaluate the role of modern radiotherapy with reduced treatment portals for stage IIA and IIB testicular seminoma.
  
  
  METHODS
  Patients with stages IIA/B disease (Royal Marsden classification) were assessable for the trial. Staging comprised computed tomography of the chest, abdomen, and pelvis as well as analysis of tumor markers alpha-fetoprotein and beta human chorionic gonadotropin. Linac-based radiotherapy was delivered to para-aortic and high ipsilateral iliac lymph nodes. The total doses were 30 Gy for stage IIA and 36 Gy for stage IIB disease.
  
  
  RESULTS
  Between April 1991 and March 1994, 94 patients were enrolled for the trial by 30 participating centers throughout Germany. Seven patients were lost to follow-up. Median time to follow-up of 87 assessable patients was 70 months. There were 66 stage IIA and 21 stage IIB patients. One mediastinal and one field-edge relapse were observed in the stage IIA group. In the stage IIB group, there was one mediastinal and one mediastinal/pulmonary relapse. All patients were treated with a salvage regimen of platinum-based chemotherapy. Actuarial relapse-free survival at 6 years was 95.3% (95% confidence interval [CI], 88.9% to 100%) and 88.9% (95% CI, 74.4% to 100%) for stage IIA and IIB groups, respectively. Maximum acute side effects were 8% grade 3 nausea for stage IIA and 10% grade 3 nausea and diarrhea for stage IIB groups. No late toxicity was observed.
  
  
  CONCLUSIONS
  Radiotherapy for stages IIA/B seminoma with reduced portals yields excellent tumor control at a low rate of acute toxicity and no late toxicity, which supports the role of radiotherapy as the first treatment choice for these patients.
authors.affiliation: Departments of Radiation Oncology and Medical Information Processing, University of Tübingen, Tübingen, Germany. johannes.classen@med.uni-tuebingen.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Classen
authors.forename: Heinz
authors.initials: H
authors.lastname: Schmidberger
authors.forename: Christoph
authors.initials: C
authors.lastname: Meisner
authors.forename: Rainer
authors.initials: R
authors.lastname: Souchon
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Sautter-Bihl
authors.forename: Rolf
authors.initials: R
authors.lastname: Sauer
authors.forename: Stefan
authors.initials: S
authors.lastname: Weinknecht
authors.forename: Kai-U
authors.initials: KU
authors.lastname: Köhrmann
authors.forename: Michael
authors.initials: M
authors.lastname: Bamberg
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D016001:Confidence Intervals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D016879:Salvage Therapy / Q000379:methods; D018239:Seminoma / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D009944:Organoplatinum Compounds