title: Adverse effects after radiotherapy for early stage (I,IIa,IIb) seminoma.
abstract: OBJECTIVE
  The evaluation of adverse effects after radiotherapy for early stage (I,IIa,IIb) seminoma.
  
  
  METHODS
  A retrospective analysis of 164 patients with stage I, IIa, IIb seminoma treated with post-orchidectomy irradiation, between 1974 and 1990 was performed. Patients had been treated with infradiaphragmatic radiotherapy only (IDRT) in 48%, and prophylactic mediastinal and left supraclavicular irradiation (supradiaphragmatic radiotherapy, SDRT) was performed additionally in the remaining 52% of patients. Median follow-up was 12 years. The incidence of late morbidity was evaluated with respect to treatment-related factors like: PTV, number of fields irradiated each day, beam energy, total dose and dose per fraction. Afterwards, the dose distribution in normal tissues-based on dose per fraction at 3 cm depth and total dose at 3 cm depth, was evaluated in relation to late morbidity.
  
  
  RESULTS
  Overall 5-year and 10-year survival was 92 and 86%. For IDRT, dose per fraction at midline and dose per fraction from AP field at 3 cm depth were not significantly associated with Gastro-Intestinal morbidity. For SDRT, dose per fraction at 3 cm depth from AP field was significantly associated with cardiac morbidity (mean-1.98 Gy in patients without and 2.27 Gy in patients with cardiac morbidity P=0.006), however total dose at 3 cm was not significantly associated with cardiac morbidity. Dose per fraction at 3 cm depth from AP field significantly (P=0.047) influenced cardiac morbidity probability in multivariate logistic regression, which included patients' age, smoking habits and total dose at 3 cm.
  
  
  CONCLUSIONS
  Excessive dose maximum in normal tissues from each fraction to anterior mediastinum is associated with increased cardiac morbidity.
authors.affiliation: Department of Radiotherapy, maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland. wmajewski1@poczta.onet.pl
authors.forename: Wojciech
authors.initials: W
authors.lastname: Majewski
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Majewski
authors.forename: Adam
authors.initials: A
authors.lastname: Maciejewski
authors.forename: Zofia
authors.initials: Z
authors.lastname: Kolosza
authors.forename: Rafal
authors.initials: R
authors.lastname: Tarnawski
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D009919:Orchiectomy; D011832:Radiation Injuries; D012189:Retrospective Studies; D018239:Seminoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D016019:Survival Analysis; D013736:Testicular Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery