Para-aortic irradiation only appears to be adequate treatment for the patients with stage I seminoma of the testis

Reviewers: Kenneth Blank, MD and Leonard Farber, MD
Source: International Journal of Radiation Oncology, Biology and Physics, 15 January 1998, Volume 40 Number 2 455

The most common tumors in men between the ages of 15 and 35 years of age are testicular tumors (also called germ cell tumors). There are two general types of germ cell tumors seminomas and non-seminomas. Clinically, seminomas are often treated with surgery and radiation while non-seminomas are often treated with surgery and chemotherapy. About half of all testicular tumors are seminomas and half non-seminomas.

Several controversies exist regarding the treatment of seminomas including whether or not men with stage I disease (that is disease limited to the testis without evidence of spread elsewhere) need radiotherapy after removal of the testis. Another controversy is whether men with stage I disease need radiotherapy (if radiotherapy is recommended) directed at the lymph nodes in the para-aortic region alone or para-aortic region and ipsilateral pelvis. For years the standard of care has been the later regimen which has provided cure rates in excess of 95%. However, radiating the ipsilateral pelvis is not without morbidity, the most serious of which is the possibility of sterility. A report out of McGill University published in the 15 January 1998 issue of the international Journal of Radiation Oncology, Biology and Physics provides support that para-aortic radiation only is sufficient for men with stage I seminoma.

Between March 1991 and January 1995, 35 patients were enrolled on this prospective study. All patients underwent a radical inguinal orchiectomy followed by radiation to then para-aortic region. Radiation fields extended from vertebral body T10 down to L5 and the radiation dose was 25Gy prescribed in 1.66 Gy daily fractions. Patients were followed for a median of 40 months at which time only one of the 35 patients had relapsed and no deaths are reported. These data are short term but provide evidence that radiation therapy does not need to include the pelvis to cure men with stage I seminoma.