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Modern Radiotherapy Results with Bulky Stages II and III Seminoma

1990; Lippincott Williams & Wilkins; Volume: 144; Issue: 3 Linguagem: Inglês

10.1016/s0022-5347(17)39555-1

1527-3792

Stephen R. Smalley, John D. Earle, Richard G. Evans, Ronald L. Richardson,

Glioma Diagnosis and Treatment

No AccessJournal of Urology1 Sep 1990Modern Radiotherapy Results with Bulky Stages II and III Seminoma Stephen R. Smalley, John D. Earle, Richard G. Evans, and Ronald L. Richardson Stephen R. SmalleyStephen R. Smalley More articles by this author , John D. EarleJohn D. Earle More articles by this author , Richard G. EvansRichard G. Evans More articles by this author , and Ronald L. RichardsonRonald L. Richardson More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)39555-1AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail We treated 20 patients with stage II seminoma by primary radiotherapy from 1971 to 1982. Median patient age was 38 years (range 26 to 52 years) and median disease width in the transverse plane was 11cm. (range 5 to 25cm.). Four tumors were 5 to 9cm., 9 were 10 to 14cm. and 7 were 15cm. or more wide. Tumor was palpable in 13 patients. Generous radiation ports (such as wide hockey stick or whole abdomen) often followed by a boost to the area of bulky disease were used as primary therapy in all patients. Median tumor dose was 37.5Gy. (range 13.3 to 56.7Gy.). Supradiaphragmatic prophylactic radiation was given to 16 patients (median dose 26Gy., range 12 to 37.3Gy.). Median followup was 56 months, and all patients currently are free of disease except for 1 who died without disease more than 10 years after completion of all therapy. Mediastinal failure occurred in 2 of 4 patients without and 1 of 16 with mediastinal prophylaxis. All 4 patients with relapse are currently free of disease after salvage therapy. Five patients 16 to 42 years old (median age 30 years) received primary radiation therapy for stage III disease. The median size of abdominal disease was 10cm. (range 5 to 17cm.). Of the 5 stage III cancer patients 3 had supradiaphragmatic disease demonstrated only in supraclavicular lymph nodes and all 3 were continuously free of disease 115 to 136 months after therapy. The remaining 2 stage III cancer patients had supradiaphragmatic disease by virtue of bulky mediastinal disease with or without supraclavicular involvement. Both patients had relapse in-field and distantly, and they died of disease despite salvage chemotherapy. A total of 30 fields with bulky disease (greater than 5cm.) was treated either primarily or at relapse among the 25 stages II and III cancer patients. In-field relapse occurred in 3 of 21 patients receiving less than or equal to 36Gy. and 0 of 9 who received greater than 36Gy. These results justify radiation therapy as an acceptable initial primary treatment modality for typical bulky stage II seminoma. Disease greater than 5cm. should receive greater than 36Gy. Prophylactic radiation to the mediastinum is effective. However, patients who have mediastinal failure often can be salvaged with chemotherapy and/or radiation, and prophylactic mediastinal radiotherapy may be associated with poor tolerance to salvage chemotherapy and other significant late effects. Our series also confirms that subsets of stage III seminoma may do well with primary radiotherapy but mortality and distant metastasis occur frequently enough to warrant chemotherapy as initial therapy in stage III disease. © 1990 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 144Issue 3September 1990Page: 685-689 Advertisement Copyright & Permissions© 1990 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen R. Smalley More articles by this author John D. Earle More articles by this author Richard G. Evans More articles by this author Ronald L. Richardson More articles by this author Expand All Advertisement PDF DownloadLoading ...