Patterns of relapse following radiotherapy for Stage I seminoma of the testis: Implications for the follow-up

A retrospective review was undertaken of 409 consecutive patients treated w ith adjuvant radiotherapy for Stage I seminoma. between 1988 and 1997. A to tal of 339 men were treated to a volume encompassing the para-aortic nodes and 70 were treated with extended field radiotherapy. The patients were fol lowed up within oncology clinics adhering to a standard protocol of clinica l examination, chest radiography and measurement of serum marker levels. No routine computed tomographic (CT) scans were carried out. At a median follow-up of 57 months, 13 patients have relapsed, giving a rec urrence-free rate of 97.2% at 3 years and 96.8% at 5 years. Of these, eight (62%) were detected at routine appointments and five (38%) requested early appointments. Chest radiography (2/5) and serum marker levels (3/5) identi fied disease in asymptomatic patients. Eight patients (62%) had raised mark ers at relapse, including two with normal serum markers at original present ation. The median size of pelvic node recurrences in the para-aortic-treate d group was 7.3 cm (2.8-13 cm). Four patients have developed second testicu lar primaries: three were detected at routine appointments and one patient had requested an early appointment. We conclude that regular follow-up with serum marker estimations and chest radiography is sufficient to detect recurrence at an early stage and that o ur policy of no routine CT scanning has been shown to give acceptable resul ts.