G. Morgan et al., MANAGEMENT OF SEMINOMA OF THE TESTIS - RECOMMENDATIONS BASED ON TREATMENT RESULTS, Australian and New Zealand journal of surgery, 67(1), 1997, pp. 15-20
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.