RADIOTHERAPY AFTER CHEMOTHERAPY FOR METASTATIC SEMINOMA - A DIMINISHING ROLE

In a retrospective study, data from 302 patients with metastatic testi cular seminoma treated with chemotherapy between 1978 and 1990 in 10 E uropean centres were analysed to evaluate the role, if any, of postche motherapy treatment with irradiation. The primary endpoint of this stu dy was the progression-free survival rate after chemotherapy with or w ithout additional radiotherapy. This was related to the type of primar y chemotherapy, sites and sizes of pre- and postchemotherapy masses, t he extent of surgical resection after chemotherapy and the use of radi otherapy. 174 patients had residual disease at the end of chemotherapy . The most important prognostic factors for progression were the prese nce of any visceral metastases or raised LDH prechemotherapy, and the presence of residual disease at visceral sites after chemotherapy. App roximately half the patients with residual masses underwent postchemot herapy radiotherapy, with selection based predominantly on institution al practice. In patients receiving platinum-based chemotherapy, no sig nificant difference was detected in progression-free survival whether or not radiotherapy was employed. Patients receiving BEP (bleomycin, e toposide and cisplatin) had a progression-free survival rate of 88% (9 5% CI, 80-96%) uninfluenced by postchemotherapy radiotherapy. In patie nts with residual masses confined to the abdomen after platinum-based chemotherapy, the absolute benefit to radiotherapy was estimated to be 2.3%. The potential benefit of postchemotherapy radiotherapy is minim al, and so it is concluded that the use of adjuvant radiotherapy to re sidual masses after platinum-based chemotherapy for metastatic seminom a is unnecessary. (C) 1997 Elsevier Science Ltd.