Treatment of early stage testicular seminoma

Stage I and IIA/B testicular seminoma represent approximately 45% of all te sticular germ cell tumours. Due to the availability of highly efficient sal vage treatment, the disease-specific survival in stage I seminoma is approx imately 100%, irrespective of the choice of adjuvant treatment. Radiotherap y with 26 Gy to the paraaortic/paracaval lymph nodes yields excellent cure rates of 95-98% with a favourable profile of acute and late toxicity. Likew ise, phase-II trials with single-agent carboplatinum systemic treatment hav e demonstrated a rate of relapse of 3-4% on average. However, carboplatinum chemotherapy has to be regarded as experimental until data of phase-III tr ials are available. Surveillance in stage I disease is conflicted with a ra te of relapse of approximately 20%. However, 80% of the patients will avoid potentially toxic overtreatment by the watch-and-wait policy. In stage IIA /B seminoma, "dogleg" radiotherapy with 30 Gy and 36 Gy, respectively, prov ides high cure rates of 90-95%. Those patients relapsing will be salvaged i n almost 100% of cases. Testicular intraepithelial neoplasia (TIN) is the c ommon precursor lesion of testicular germ cell tumours except for spermatoc ytic seminoma. In case of TIN in a single testis or bilateral TIN, local ra diotherapy with 18 Gy is recommended as standard treatment.