Radiotherapy for stage II testicular seminoma☆

Abstract 

To compare the outcome of patients with Stage II seminoma treated with prophylactic mediastinal irradiation, without any supradiaphragmatic irradiation, and with prophylactic left supraclavicular irradiation (PLSCI).

Between 1960 and 1999, 73 men with Stage II seminoma received postorchiectomy radiotherapy. Before 1984, 36 received prophylactic mediastinal irradiation (Series I); between 1984 and 1992, 17 received no supradiaphragmatic irradiation (Series II); and after 1992, 20 received PLSCI (Series III). The outcomes in these series were compared.

The abdominal tumor sizes were as follows: Series I, ≤2 cm, n = 4; >2 and ≤5 cm, n = 12; >5 and ≤10 cm, n = 16; Series II, ≤2 cm, n = 1; >2 and ≤5 cm, n = 12; >5 and ≤10 cm, n = 4; and Series III, ≤2 cm, n = 1; >2 and ≤5 cm, n = 14; >5 and ≤10 cm, n = 5 (p = 0.75). The median duration of follow-up was 14.4, 9.3, and 4.5 years for Series I, II, and III, respectively. The 6-year freedom from relapse was 94%, 71%, and 95% for Series I, II, and III, respectively. The differences between Series I and II (p = 0.014) and between II and III (p = 0.042) were significant. Three patients in Series II had a relapse in their left supraclavicular fossa—a failure pattern abrogated by PLSCI.

PLSCI significantly diminishes the likelihood of relapse for Stage IIA, IIB, and IIC seminoma (mass ≤10 cm).

Keywords:  Seminoma, Radiotherapy, Stage II, Abdominal metastasis, Prophylactic radiation