PROGNOSIS OF HUMAN CHORIONIC GONADOTROPIN-PRODUCING SEMINOMA TREATED BY POSTOPERATIVE RADIOTHERAPY

Purpose: To clarify the controversy about the management and prognosis of human chorionic gonadotropin-producing seminoma, the records of 13 2 patients with abnormal human chorionic gonatropin values treated wit h radiotherapy were analyzed. Methods and Materials: The records of 11 69 patients with pure seminoma treated in 10 institutions were screene d for serum or urinary human chorionic gonadotropin. One hundred and t hirty two patients with elevated human chorionic gonadotropin were fou nd: 96 Stage 1, 20 II(A), 7 II(B), 8 III and 1 IV. Median age was 34 y ., mean follow-up was 5.0 years [range 1-12 y]. All received infradiap hragmatic radiotherapy (median dose 30 Gy), 25 (2 Stage 1, 11 II(A), 5 II(B) and 7 III) supradiaphragmatic radiotherapy (median dose: 28.5 G y) and 10 had also initial chemotherapy (3 Stage II(B) 6 III and 1 IV) . Patients were allocated to three groups according to human chorionic gonadotropin values: (a) moderate elevation: up to 10 times (104 pts) , (b) high elevation: 10 to 100 times (20 pts), (c) very high elevatio n: over 100 times the upper limit of normal value (8 pts). Results: Th e proportion of Stage 1, II and III was 76%, 19%, 5% in the ME group v ersus 50%, 35%, 15% in the high elevation group (p < 0.05). In the ver y high elevation group there were 7 Stage I and 1 Stage IV. Of 132 pat ients, six died (three dead of disease, two suicides, one acquired imm unodeficiency syndrome). The 5 years overall survival probability was 94%. There were seven recurrences (initial stage: 1 Stage I, 2 II(B), 3 III and 1 IV). Of these, there were one infield recurrence, 3 out of field and 3 in both sites. In 5 of 7, the human chorionic gonadotropi n level was again elevated at recurrence. The 5 years recurrence-free- survival probability was 94% (98% for Stage I, 100% for Stage IIA and 65% for Stage II(B) and III [p < 0.001 between I and II(B) + III, p < 0.05 between II(A) and II(B) + III]). Four of the 7 recurrences were s alvaged by chimiotherapy +/- radiotherapy. In the high elevation and v ery high elevation groups, the 5 years recurrence-free-survival was 88 %, vs. 96% for the moderate elevation group (p = 0.10). Conclusion: Ba sed on this series of patients, human chorionic gonadotropin productio n is not an unfavorable prognostic factor in pure seminoma. Even in th e subgroups with high or very high human chorionic gonadotropin levels (who had a higher proportion of advanced stages), the prognosis remai ned excellent. In Stage I and II(A) seminoma with abnormal human chori onic gonadotropin levels, recurrence rate after post-operative radioth erapy alone is extremely low.