Preferred treatment for stage I seminoma: a survey of Canadian radiation oncologists.

摘要

About one-half of all patients with testicular germ cell tumours present with a seminoma. Of these, about 85% present with stage I disease. Numerically, therefore, stage I seminoma makes up the most common patient group seen in testicular cancer clinics. Experience in the 1980s suggests that, without adjuvant treatment, about 15-20% of patients who are stage I at diagnosis relapse at some stage, usually within the subsequent 3 years, but potentially over a more extensive period of time. In the latter half of the 20th century these patients were traditionally managed with adjuvant radiotherapy to reduce this risk of relapse. Multiple studies have shown that after radiotherapy the overall risk of relapse lies between 2% and 4%. The traditional field includes radiotherapy to the para-aortic lymph nodes, renal hilar lymph nodes and the ipsilateral pelvic lymph nodes ('dogleg' field) to a dose of around 30 Gy in 2 Gy fractions. In the 1990s a series of trials led by the UK Medical Research Council (MRC) clinical trials group showed that radiotherapy to just the para-aortic lymph nodes and to a dose of 20 Gy in 2 Gy fractions was sufficient.