title: A risk-adapted strategy of radiotherapy or cisplatin-based chemotherapy in stage II seminoma.
abstract: OBJECTIVE
  Indications for radiotherapy and chemotherapy in stage II seminoma are currently debated.
  
  
  METHODS
  Since 1980, the policy at Institut Gustave Roussy was to treat patients with stage IIA-B disease with external radiotherapy and patients with stage IIB-C with cisplatin-based chemotherapy. In stage IIB disease, 3 cm was the usual tumor size threshold above which individual patients were considered for chemotherapy.
  
  
  RESULTS
  During the period 1980-2001, 67 patients with stage II seminoma were treated: stage IIA (n = 5), stage IIB (n = 31), and stage IIC (n = 31). The median age was 40 years (range: 23-64). Among 37 patients who received radiotherapy, 5, 28, and 4 had a stage IIA, IIB, and IIC, respectively. Among 30 patients who received chemotherapy, 27 had a stage IIC. With a median follow-up of 9.4 years, 19 relapses (28%) occurred, including 11 and 8 cases treated with radiotherapy (30%) and chemotherapy (27%), respectively. The 5-year relapse-free survival was 71% (95% CI: 59-80). All but three relapses were salvaged with chemotherapy followed in selected cases by surgical resection of residual masses. Only 3 patients died of seminoma. The 5-year overall survival rate is 97% (95% CI: 89-99). Five patients subsequently developed a non-germ-cell second cancer, which occurred within the radiation field in 3 cases.
  
  
  CONCLUSIONS
  With an overall survival rate of 97%, the overall outcome of patients with stage II seminoma managed according to this risk-adapted strategy is good. The possibility of extending the indications for chemotherapy to selected stage IIB seminoma patients needs to be further evaluated as potentially beneficial in terms of relapse risk.
authors.affiliation: Department of Medicine, Institut Gustave Roussy, Villejuif, France. julien.domont@igr.fr
authors.forename: Julien
authors.initials: J
authors.lastname: Domont
authors.forename: Christophe
authors.initials: C
authors.lastname: Massard
authors.forename: Anna
authors.initials: A
authors.lastname: Patrikidou
authors.forename: Alberto
authors.initials: A
authors.lastname: Bossi
authors.forename: Renaud
authors.initials: R
authors.lastname: de Crevoisier
authors.forename: Mathieu
authors.initials: M
authors.lastname: Rose
authors.forename: Pierre
authors.initials: P
authors.lastname: Wibault
authors.forename: Karim
authors.initials: K
authors.lastname: Fizazi
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D004427:Ear Diseases / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000209:etiology; D009422:Nervous System Diseases / Q000209:etiology; D012307:Risk Factors; D018239:Seminoma / Q000473:pathology / Q000628:therapy*; D013736:Testicular Neoplasms / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin