POSTSURGICAL POLICY IN STAGE-I TESTICULAR SEMINOMA - COST AND BENEFITOF PROPHYLACTIC IRRADIATION IN A LONG-TERM EXPERIENCE

The definitive cure rate for clinical stage I testicular seminoma is v ery close to 100%, and prophylactic irradiation of the regional lymph nodes is associated with a low morbidity. Nevertheless, in recent year s a ''wait-and-see'' policy has been proposed by some researchers, We analysed the cost/benefit ratio of radiotherapy (RT) by review of the case histories of 299 patients treated at the Department of Radiothera py. of the Istituto Nazionale per lo Studio e la Cura dei Tumori In Mi lan from January 1968 to December 1989. The 5-year overall survival wa s 99% (97.5% at 10 years), while the 10-year disease-free survival was 96%. The recurrence rate was 2.3%, but no patient relapsed in the irr adiated areas, Acute toxicity was very moderate with only 4 (1.3%) ser ious radiation sequelae occurring 6 to 27 years after treatment. Howev er, 9 second malignancies (3%) were observed. Lastly, we have calculat ed the costs for our National Health Service comparing surveillance po licy and prophylactic irradiation.