title: Excellent long-term disease control with modern radiotherapy techniques for stage I testicular seminoma--the Mayo Clinic experience.
abstract: OBJECTIVE
  The objectives of this study are to examine the long-term efficacy and adverse effects of adjuvant radiotherapy (RT) for stage I testicular seminoma.
  
  
  METHODS
  A retrospective review was conducted in 199 patients with stage I testicular seminoma treated with curative intent orchiectomy and adjuvant megavoltage RT at the institution from January 1, 1972 through December 31, 2009. Computed tomography staging was performed for 90% of the patients. No patient received mediastinal RT or adjuvant chemotherapy. Overall survival (OS), cause-specific survival, relapse rate, major cardiac event (MCE), and second malignancy (SM) were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  The median age of the patients was 36 years (range: 18-80). The nodal regions irradiated were the para-aortic and ipsilateral pelvic nodes in 147 patients (74%), the para-aortic nodes alone in 34 (17%), and the para-aortic and bilateral pelvic nodes in 18 (9%). The median RT dose was 25.5 Gy (interquartile range: 25-30). The median follow-up after RT was 13 years (range: 0.1-37). OS at 10 and 20 years was 92% and 77%, respectively. Cause-specific survival at 10 and 20 years was both 99%. Risk of relapse at 10 and 20 years was 1% and 2%, respectively. Risks of MCE and SM at 20 years were 12% and 19%, respectively.
  
  
  CONCLUSIONS
  This series confirms an excellent outcome in patients with stage I testicular seminoma treated with RT. Relapse after adjuvant RT is very uncommon, but late morbidity associated with RT may occur.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Hallemeier
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN. Electronic address: choo.c@mayo.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Choo
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Davis
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Costello
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Pisansky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000532:radiotherapy; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D018239:Seminoma / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Radiotherapy; Seminoma; Testicular neoplasms