RADIATION-THERAPY FOR STAGE-I AND STAGE-IIA TESTICULAR SEMINOMA

Purpose: To review the survival, cure rate, treatment morbidity, and l ate sequelae of histologically confirmed seminoma patients who underwe nt orchiectomy and radiation therapy at the Radiation Oncology Center, Mallinckrodt Institute of Radiology, from 1964 to 1988. Methods and M aterials: There were 128 patients, with a median patient age of 37 yea rs (range, 17-79 years). Follow-up ranged from 1-24 years, with a medi an of 6.7 years. There were 95 patients with Stage I and 33 with Stage IIA disease. All patients were treated with orchiectomy followed by i liac and paraaortic irradiation (median tumor dose: 2500 cGy for Stage I and 3400 cGy for Stage IIA patients). Twenty-five of 33 patients wi th Stage IIA disease received prophylactic mediastinal and left suprac lavicular irradiation (median dose, 2700 cGy). Results: For patients w ith Stage I disease, 5-year disease-free survival, overall survival, a nd survival corrected for intercurrent disease were 97%, 100%, and 100 %, respectively. For patients with Stage IIA disease, the 5-year disea se-free survival, overall survival, and survival corrected for intercu rrent disease were 93%, 89%, and 97%, respectively. Four patients (3%) had recurrences; all were outside the radiation treatment field. Thre e of four were successfully salvaged with chemotherapy and rendered di sease-free; the other patient refused treatment. There were no mediast inal recurrences whether prophylactic mediastinal irradiation was admi nistered or not. Bowel obstruction and necrosis developed in one patie nt who received 3363 cGy midplane dose to the pelvic and paraaortic ar eas as well as additional intraperitoneal colloidal Au-198 (150 mCi) f or a ruptured seminoma from an undescended testis. Conclusion: In summ ary, radical orchiectomy and irradiation of the iliac and paraaortic l ymphatics is the treatment of choice for patients with Stage I and IIA testicular seminoma.