Short course para-aortic radiation for stage I seminoma of the testis.
OBJECTIVE
To determine the outcome in men with Stage I seminoma treated with low-dose para-aortic radiation.


METHODS
Between January 1988 and December 2000, 431 men with Stage I seminoma were treated with para-aortic radiation to a midplane dose of 20 Gy in 8 fractions over 10 days.


RESULTS
At a median follow-up of 62 months, 15 patients (3.5%) had relapsed, with a median time to relapse of 13 months (range: 9 to 39 months). Nine patients had pelvic nodal relapse; in addition, 1 patient had para-aortic involvement, and 2 had distant disease. Four had metastatic disease only (mediastinum 2, lung 2). One patient had scrotal recurrence, and 1 was treated for progressive rise in human chorionic gonadotrophin without identifiable disease. Initial treatment at relapse was chemotherapy (12), radiation (2), and surgery (1). One patient died from progressive disease. Thirteen men (3%) have developed second malignancies, including 7 contralateral testicular tumors, 5 solid malignancies, and 1 leukemia. The overall 5-year survival was 98%, and the estimated recurrence-free survival at 5 years was 96.3%. On log-rank univariate analysis, lymphovascular invasion, involvement of the tunica, and a preoperative human chorionic gonadotrophin level of greater than 5 were found to be of prognostic significance for recurrence.


CONCLUSIONS
These data support short-duration, limited-field radiation as an optimal safe and effective protocol in the management of Stage I seminoma patients.
Logue
John P
JP
Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester, United Kingdom. johnlogue@christie-tr.nwest.nhs.uk
Harris
Margaret A
MA
Livsey
Jacqueline E
JE
Swindell
Richard
R
Mobarek
Nabil
N
Read
Graham
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology; D018239:Seminoma / Q000473:pathology / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000532:radiotherapy*