Long-term results of para-aortic irradiation for patients with stage I seminoma of the testis.
OBJECTIVE
Adjuvant postoperative para-aortic lymph nodal irradiation is an acceptable alternative to para-aortic and ipsilateral pelvic irradiation postorchiectomy for patients with Stage I seminoma of the testis. In this article, we report the long-term results of our prospective evaluation of para-aortic irradiation only for such patients.


METHODS
Between March 1991 and September 2000, 71 patients with Stage I seminoma were treated with adjuvant irradiation to the para-aortic region only after radical inguinal orchiectomy. Radiotherapy was delivered using parallel-opposed fields extending from T11 to L5. A total dose of 25 Gy in 15 fractions was prescribed to midpoint. Follow-up was performed every 3 months for the first year, every 4 months for the second and third years, every 6 months for the fourth and fifth years, and annually thereafter. Chest X-ray, tumor markers, and computed tomography scan of the pelvis were performed routinely as part of the follow-up investigation.


RESULTS
At a median follow-up of 75 months, 68 of 71 patients are alive and free of relapse. Only 1 patient (1.4%) experienced failure in the ipsilateral inguinal nodal region. Two patients (2.8%) died of unrelated causes. The actuarial 10-year relapse free survival is 98.5% and the actuarial 10-year overall survival is 92%. No late toxicity has been encountered.


CONCLUSIONS
Patients with Stage I seminoma of the testis may be safely treated with para-aortic radiotherapy only. Risk of pelvic failure is very low and treatment toxicity minimal.
Niazi
Tamim M
TM
Department of Oncology, Division of Radiation Oncology, McGill University Health Center, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada.
Souhami
Luis
L
Sultanem
Khalil
K
Duclos
Marie
M
Shenouda
George
G
Freeman
Carolyn
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D018239:Seminoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D013736:Testicular Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*