Stage I seminoma of the testis. Adjuvant radiotherapy or surveillance?

Br J Urol. 1991 Aug;68(2):190-4. doi: 10.1111/j.1464-410x.1991.tb15293.x.

Abstract

Lately the role of radiotherapy in stage I seminoma of the testis has been questioned by some authors who reported on a "surveillance" strategy for these patients. Since 1980, 124 patients with seminoma of the testis have been referred to this institution; 97 of 116 patients analysed presented with stage I disease and 10 of these had elevated levels of beta HCG. A total of 64 patients were given radiotherapy after orchiectomy and 33 entered a surveillance protocol. After a median follow-up of 48 months, 3 patients in the surveillance group relapsed after 5, 13 and 49 months and 2 of the irradiated patients did so after 25 and 33 months. Elevation of beta HCG was not significant because none of these patients showed progression. A low rate of progression and excellent survival are associated with standard treatment (orchiectomy and radiotherapy) and good results have been achieved with chemotherapy in cases of relapse. A surveillance policy is not recommended in stage I seminoma because of its slower growth compared with non-seminomatous germ cell tumours (NSGCT), the absence of a specific tumour marker, the 10% risk of occult metastases and the 3-fold higher progression rate compared with irradiated patients. We suggest the use of a reduced dosage and radiation field.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Chorionic Gonadotropin / blood
  • Chorionic Gonadotropin, beta Subunit, Human
  • Combined Modality Therapy
  • Dysgerminoma / blood
  • Dysgerminoma / pathology
  • Dysgerminoma / radiotherapy*
  • Dysgerminoma / surgery
  • Humans
  • Male
  • Middle Aged
  • Orchiectomy
  • Peptide Fragments / blood
  • Recurrence
  • Testicular Neoplasms / blood
  • Testicular Neoplasms / pathology
  • Testicular Neoplasms / radiotherapy*
  • Testicular Neoplasms / surgery

Substances

  • Chorionic Gonadotropin
  • Chorionic Gonadotropin, beta Subunit, Human
  • Peptide Fragments