STAGE-I TESTICULAR SEMINOMA - RESULTS OF ADJUVANT IRRADIATION AND SURVEILLANCE

Purpose: To assess the results of treatment and patterns of relapse in a contemporary group of patients with stage I testicular seminoma man aged by adjuvant radiation therapy (RT) and surveillance. Patients and Methods: Between January 1981 and December 1991, 364 patients with st age I seminoma were treated at Princess Margaret Hospital. Of these, 1 94 were treated with adjuvant PT (92% received a dose of 25 Gy in 20 f ractions for 4 weeks) and 172 were managed by surveillance, Two patien ts were included in this series twice-both had postorchiectomy PT for stage I disease, developed a contralateral seminoma, and were placed o n surveillance and analyzed for outcome of both primary tumors. The me dian follow-vp period for patients treated with adjuvant PT was 8.1 ye ars (range, 0.2 to 12), and for patients managed by surveillance, it w as 4.2 years (range, 0.6 to 10.1). Results: The overall 5-year actuari al survival rate for all patients was 97%, and the cause-specific surv ival rate was 99.7%. Only one patient died of seminoma. Of 194 patient s treated with RT, 11 have relapsed, with a 5-year relapse-free rate o f 94.5%. Prognostic factors for relapse included histology, tunica inv asion, spermatic cord involvement, and epididymal involvement. Twentys even patients developed disease progression on surveillance, which res ulted in a 5-year progression-free rate of 81.9%. The only factor iden tified to predict progression on surveillance was age at diagnosis: pa tients aged less than or equal to 34 years had a 26% risk of progressi on at 5 years, in contrast to a 10% risk of progression in those great er than 34 years of age. Conclusion: The outcome of patients with stag e I testicular seminoma is excellent, with only one of 364 patients (0 .27%) dying of disease. In our experience, both a policy of adjuvant P T and of surveillance resulted in a high probability of cure. Our surv eillance experience showed that four of five patients with stage I sem inoma are cured with orchiectomy alone. The benefit of adjuvant RT was reflected in ct decreased relapse rate. We have identified a number o f prognostic factors for relapse in patients managed with both approac hes, but further study of prognostic factors is required, particularly to identify patients at high risk of disease progression on surveilla nce. (C) 1995 by American Society of Clinical Oncology.