Testicular seminoma: results of the Yale University experience, 1964-1984

Article Abstract:

In about 95 percent of patients with seminoma, the tumor is confined to the testicle (Stage I), or with spread limited to abdominal or para-aortic lymph nodes (Stage II). Seminomas are exceptionally sensitive to radiation, and the recommended therapy consists of surgery and radiation. Recently, however, cisplatin-based chemotherapy has been shown to be effective for advanced Stage II seminomas, and Stages III and IV, which involve spread above the diaphragm and outside the lymphatic system, respectively. The emergence of new chemotherapeutic procedures prompts a review of cases to determine if surgery and radiotherapy should remain the recommended therapy for Stages I and II. Over a 20-year period ending in 1984, 83 testicular seminoma patients were seen at Yale University. Sixty-one had Stage I disease, while 15 had Stage IIA and 3 patients Stage IIB, which differ only in the larger size (greater than 5 cm) of IIB tumors. Of the Stage I patients, only one developed a recurrence, and this was at the edge of the irradiated area, and probably represents tumor which had escaped exposure to radiation. None of the Stage II patients, who received a higher radiation dose than Stage I patients, developed a recurrence of seminoma. Two patients, however, developed other cancers. Of the patients with advanced disease, only one remains disease-free. Only two patients with Stage I disease received prophylactic mediastinal and left supraclavicular (PMLS) radiation. It had been thought that this would decrease the probability of recurrences above the diaphragm, but early in this study the practice was discontinued and 59 patients did not receive PMLS radiotherapy, and none developed mediastinal recurrences. The question of PMLS radiation for stage IIA patients remains controversial; this study does not provide sufficient data to determine if the risk of metastases (or spread) is sufficient to justify the risk of cancer caused by the radiotherapy itself. Other studies have suggested that the use of PMLS is not justified for Stage IIA disease; this study clearly shows it is not, for Stage I disease. Additional radiation may also reduce the effectiveness of salvage chemotherapy if a tumor should occur. Although chemotherapy has been shown to be effective in advanced seminoma, surgery and radiation remain the treatment of choice for the majority of cases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Chemotherapy, Yale University

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Treatment results and acute and late toxicity of radiation therapy for testicular seminoma

Article Abstract:

The effects and toxicity of radiation therapy were assessed in 197 patients with testicular seminoma, a tumor of the testis. The patients were classified according to the stages of the cancer, with 133 patients in Stage I, 39 in Stage II, 8 in Stage III, and 17 in Stage IV. The seminoma was anaplastic or characterized by loss of cell development and function in 17 patients, whereas 180 patients had classic features of the cancer. All patients underwent surgery to remove the testicles before radiation therapy, and seven patients from Stages II and IV received chemotherapy or anticancer drugs before radiotherapy. Patients with Stage I and II seminoma received radiation in the abdominal and pelvic regions, whereas 10 patients with Stage III and IV seminoma received additional radiation treatment applied to the midchest area and above the collarbone. Sixty patients received additional radiation treatment to the groin region. The survival rate at five years was 100 percent for Stage I and II patients, and 87 percent for Stage III and IV patients. Patients were followed-up for a period of about six years. All patients had similar tissue microscopic features and prior chemotherapy. Irradiation of the midchest area and above the collarbone did not improve outcome. Acute or immediate toxic effects of radiation included mild to moderate vomiting, increased bowel frequency, skin redness, and decreased numbers of white blood cells and platelets (cells involved in clotting). One patient died of pulmonary fibrosis, the formation of fiber-like tissue in the lungs, one month after midchest radiation therapy and two months after chemotherapy. Another patient developed a gastrointestinal ulcer one and a half months after abdominal radiation and prior to treatment with several anticancer drugs. These findings suggest that the use of lower doses of radiation will prevent overtreatment and reduce the incidence of extensive disease in patients with testicular seminoma. Radiation therapy may not be necessary after surgical removal of the testicles in patients with stage I and, possibly, stage II cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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Staging, treatment, and results in testicular seminoma: a 12-year report

Article Abstract:

Seminomas, germ cell cancers of the testes, are quite radiosensitive, and radiotherapy for this disease has an 80 to 97 percent success rate. Nonetheless, proper evaluation of the tumor is necessary in order to plan appropriate therapy after surgical removal of the tumor. Over a twelve-year period, 61 patients with seminoma were treated. Their tumors were carefully graded on a scale of I to IV, although only stages I and II were actually observed in the study group. Patients were treated with an average total dose of 25 Gary (1 Gary equals 1 joule of energy absorbed per kilogram of tissue). The 42 patients with stage I tumors, which are confined to the testicle, had a 100 percent five-year survival rate. Stage II tumors have some involvement of lymph nodes below the diaphragm; stage IIA have minimal metastasis behind the peritoneal cavity. The 16 patients with stage IIA tumors were treated with radiation covering greater areas, including a prophylactic dose to the chest. These patients had a 100 percent five-year survival rate. The study only included three patients with stage IIB disease, in which a bulky metastatic mass was seen behind the peritoneum. The survival rate for these patients was two out of three, but because of the small number of patients in this group, no quantitative conclusions can be made. From a review of the literature, it appears that stage IIB seminomas should be treated with cisplatin-based chemotherapy followed by radiation as necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

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