Is radiotherapy a good adjuvant strategy for men with a history of cryptorchism and stage I seminoma?
OBJECTIVE
Men with cryptorchism can have aberrant abdominopelvic lymph node (LN) drainage or a different natural history if they develop Stage I seminoma. If so, the nodal echelons for metastases will not be reliable, and adjuvant radiotherapy (RT) would not be an ideal strategy.


METHODS
Two prospectively maintained oncology databases were reviewed for men with a history of testicular seminoma and cryptorchidism. The primary endpoint was the 5-year relapse-free rate.


RESULTS
A total of 23 men were identified, most (n = 13) had had a tumor in a scrotal location after orchiopexy. After orchiectomy, 5 men were managed with surveillance, and 18 underwent RT to a median dose of 25 Gy (range, 20-30 Gy). All the radiation fields included the para-aortic LNs, and 13 included the ipsilateral pelvic LNs. After a median follow-up of 64 months (range, 2-148), 2 patients developed a relapse. One did so 4 months into a surveillance program in the para-aortic and ipsilateral pelvic LNs, sites that would have been treated had he undergone RT. The other patient developed a relapse in the contralateral testis 46 months after having undergone RT. It is likely that the latter patient had a metachronous primary rather than a relapse; hence, the 5-year relapse-free rate was 80% for surveillance and 100% for RT. Both patients underwent successful salvage treatment, and all patients were disease free and alive at the last follow-up visit.


CONCLUSIONS
A history of cryptorchism does not appear to confer a greater risk of relapse for men with Stage I seminoma managed with radiotherapy. RT, surveillance, and adjuvant carboplatin chemotherapy are treatment options for these patients.
Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia. jarad.martin@roq.net.au
Jarad M
JM
Martin
Peter
P
Gorayski
Daniel
D
Zwahlen
Michael
M
Fay
Jacqui
J
Keller
Jeremy
J
Millar
D000328:Adult; D003456:Cryptorchidism / Q000150:complications* / Q000473:pathology / Q000601:surgery; D016208:Databases, Factual; D018572:Disease-Free Survival; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D056126:Orchiopexy / Q000009:adverse effects; D011793:Queensland; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy; D018239:Seminoma / Q000150:complications / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D013736:Testicular Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy*; D047368:Tumor Burden; D014739:Victoria