Low-dose radiotherapy for Stage I seminoma--long-term results.
OBJECTIVE
The aim of this study was to review retrospectively the results of low-dose radiotherapy for Stage I seminoma using four different fractionation schedules and target volume definitions.


METHODS
A total of 191 patients underwent irradiation for histologically proven Stage I seminoma after undergoing an inguinal orchiectomy. Fractionation schedules were used one after another as follows: Total dose 30 Gy (dose/fraction 1.5 Gy, 16 patients), total dose 25.5 Gy (dose/fraction 1.5 Gy, 62 patients), total dose 20 Gy (dose/fraction 2 Gy, 69 patients), total dose 26 Gy (dose/fraction 2 Gy, 29 patients). The remaining 12 patients were excluded from this study. In the same period the target volume was gradually reduced. In 1983 the paraaortic, pelvic and inguinal regions were irradiated; later the target volume was reduced to the paraaortic region exclusively.


RESULTS
Overall survival and event-free survival were identical in all groups ranging from 95% to 100% /5 years. Three patients experienced a lymph node metastasis during follow-up, 3 patients a distant metastasis to the lung and the bones. Mild acute side effects were noted in 8% to 15% of the patients, and very mild long-term side effects in 1% to 5% of patients. Multivariate analysis showed no prognostic significance of total dose, dose per fraction, or target volume. In univariate analysis, a higher frequency of acute side effects to the skin and the bowel was related to a higher total dose, and an elevated frequency of nausea was related to a higher daily dose per fraction.


CONCLUSIONS
Using lower doses and limiting the target volume to the paraaortic region exclusively did not result in a worse prognosis in our patient series.
Niewald
Marcus
M
Department of Radiooncology, Saarland University Hospital, Homburg, Germany. ramnie@uniklinikum-saarland.de
Freyd
Johanna
J
Fleckenstein
Jochen
J
Wullich
Bernd
B
Rübe
Christian
C
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control; D020266:Radiotherapy, Conformal / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018239:Seminoma / Q000401:mortality* / Q000532:radiotherapy*; D016019:Survival Analysis; D015996:Survival Rate; D013736:Testicular Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D016896:Treatment Outcome