LONG-TERM EVALUATION OF POSTORCHIECTOMY RADIOTHERAPY FOR STAGE-II SEMINOMA

Purpose: To determine survival, long-term tumor control, and the effec ts of irradiation for stage II seminoma. Materials and Methods: Forty- five patients with stage II testicular seminoma were treated between 1 966 and 1989. There were 31 patients with stage IIA disease and 14 wit h stage IIB disease. All patients underwent orchiectomy followed by il iac and paraaortic irradiation (median dose: 30 Gy), with 37 patients receiving prophylactic mediastinal and supraclavicular irradiation (me dian dose: 30 Gy). Follow-up ranged from 6 months to 20.6 years, with a median of 9.4 years. Results: Uncorrected survival was 98% at 5 year s, 84% at 10 years, and 79% at 15 years. Survival corrected for interc urrent disease was 98% at 5, 10, and 15 years. Five patients developed recurrences with four successfully salvaged by chemotherapy and/or ir radiation. There were no serious acute toxicities, and no late complic ations have developed from infradiaphragmatic irradiation. Supradiaphr agmatic irradiation was associated with an increased risk of coronary artery disease compared to the age-matched general population. Conclus ion: Radiotherapy remains an effective treatment for stage II testicul ar seminoma, with a 98% adjusted survival rate at 15 years, without se rious acute toxicity. Supradiaphragmatic irradiation should not be use d in stage IIB patients for whom salvage chemotherapy is an option.