Radiotherapy for Stage II testicular seminoma

Purpose: To compare the outcome of patients with Stage H seminoma. treated with prophylactic mediastinal irradiation, without any supradiaphragmatic i rradiation, and with prophylactic left supraclavicular irradiation (PLSCI). Methods and Materials: Between 1960 and 1999, 73 men with Stage Il seminom a. received postorchiectomy radiotherapy. Before 1984, 36 received prophyla ctic mediastinal irradiation (Series I); between 1984 and 1992, 17 received no supradiaphragmatic irradiation (Series II); and after 1992, 20 received PLSCI (Series III). The outcomes in these series were compared. Results: The abdominal tumor sizes were as follows: Series I, less than or equal to2 cm, n = 4; >2 and less than or equal to5 cm, n = 12; >5 and less than or equal to 10 cm, n = 16; Series II, less than or equal to2 cm, n = 1 ; >2 and less than or equal to5 cm, n = 12; >5 and less than or equal to 10 cm, n = 4; and Series III, less than or equal to2 cm, n = 1; >2 and less t han or equal to5 cm, n = 14; >5 and less than or equal to 10 cm, n = 5 (p = 0.75). The median duration of follow-up was 14.4, 9.3, and 4.5 years for S eries I, II, and III, respectively. The 6-year freedom from relapse was 94% , 71%, and 95% for Series I, II, and III, respectively. The differences bet ween Series I and II (p = 0.014) and between H and III (p = 0.042) were sig nificant. Three patients in Series If had a relapse in their left supraclav icular fossa-a failure pattern abrogated by PLSCI. Conclusions: PLSCI significantly diminishes the likelihood of relapse for S tage IIA, IIIB, and IIC. seminoma (mass less than or equal to 10 cm). (C) 2 001 Elsevier Science Inc.