Stage I seminoma of the testis: a bi-institutional retrospective analysis of patients treated with radiation therapy only.
OBJECTIVE
To analyse relapse patterns, toxicity and second malignancy in patients with stage I pure germ cell testicular tumours, treated in 1970-1999.


METHODS
In all, 487 patients received irradiation after surgery to the infra- (407, 83.5%) or infra- and supra-diaphragmatic volumes (80, 16.5%). Treatment-related toxicity was classified according to previous criteria and fertility investigated in 246 men. Second malignancies were identified by retrospective analysis of clinical records or telephone interviews in men who no longer needed a long-term follow-up.


RESULTS
The 10-year overall survival was 97% (98% and 96%, respectively, for the aortic nodes only, or aortic and iliac nodes, i.e. the 'dog leg' field) and disease-free survival was 94%. Twenty-one patients relapsed (five with a true 'in-field' recurrence, nine progressed to the mediastinum, and seven had disseminated disease). Acute toxicity was mainly gastrointestinal, with 7.6% classified as grade II. In all, 73 men achieved paternity after irradiation; nine did not but had normal sperm. Second malignancies were diagnosed in 16 (3.3%) men.


CONCLUSIONS
Para-aortic irradiation may be used safely in patients with stage I seminoma and undisturbed testicular drainage, with equivalent results to the 'dog-leg' group; these unrandomized data confirm the lower toxicity and equivalent survival rates of this treatment.
Santoni
R
R
Radiation Oncology Departments, University of Firenze, Firenze, University of Rome, Tor Vergata, Roma, Italy. riccardo.santoni@uniroma2.it
Barbera
F
F
Bertoni
F
F
De Stefani
A
A
Livi
L
L
Paiar
F
F
Scoccianti
S
S
Magrini
S M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D007248:Infertility, Male / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D018239:Seminoma / Q000532:radiotherapy*; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000532:radiotherapy*; D016896:Treatment Outcome