MANAGEMENT OF SEMINOMA OF THE TESTIS - RECOMMENDATIONS BASED ON TREATMENT RESULTS

Background: The results of management of seminoma of the testis at the Department of Radiation Oncology St Vincent's Hospital, Sydney were e valuated retrospectively to: (i) establish that outcomes were in keepi ng with published results from centres in Australia and overseas; (ii) assess the impact of chemotherapy on management; and (iii) to determi ne 'best practice' management protocols based on our results and a rev iew of the relevant literature. Methods: (i) Assessment of treatment r esults for stage I and II seminoma of the testis treated by post-orchi dectomy radiotherapy and/or chemotherapy at St Vincent's Hospital betw een 1979 and 1993; (ii) literature review of published data from Austr alian and overseas centres on the management of seminoma of the testis , and in particular the use of surveillance or chemotherapy either alo ne, at time of relapse or combined with radiotherapy; and (iii) develo pment of recommendations for use as management protocols in our depart ment. Results: Our data and a review of the literature suggest that po st-orchidectomy radiotherapy with chemotherapy for relapse in stage I and IIA disease results in long-term cure rates approaching 100%. Trea tment with chemotherapy either routinely or selectively or using a sur veillance policy is unlikely to show any improvement in outcome and ma y be less cost-effective and/or produce increased morbidity and the ri sk of secondary leukaemia. For stage IIB disease (5-10 cm) the use of initial combination chemotherapy with or without subsequent radiothera py did not appear to give better outcomes than initial radical radioth erapy alone, reserving chemotherapy or further radiotherapy for relaps e. For bulkier stage IIB disease (> 10 cm), the use of initial chemoth erapy plus consolidation radiotherapy appeared to be an appropriate tr eatment. Conclusions: Management protocols for seminoma of the testis at St Vincent's Hospital, Sydney Department of Radiation Oncology curr ently are (i) stage I, IIA and IIB (5-10 cm): post-orchidectomy radiot herapy alone with chemotherapy or further radiotherapy for relapse; an d (ii) stage IIB (> 10 cm) disease: initial chemotherapy post-orchidec tomy followed by radiotherapy to sites of initial disease involvement.