Radiotherapy in Stage IIA and IIB Testicular Seminoma With Reduced Portals: A Prospective Multicenter Study

Purpose: A prospective multicenter study was cat-tied out to esthnate the treatment outcome of radlotherapy in Stage II seminoma after the application of modern stag& and radIotherapy techniques. The lower margin of the iliac tield was positioned on the upper rim of the acetabulum to reduce the amount of scattered irradiation to the remah&tg testicle. Methods and Materlals: The study was cart-led out in 25 centers in Germany. Patients with pure semlnoma, ne8atlve A&P-v&es, and retroperltoneal lymph node metastases of less than 5 cm ht diameter were entered into the study. All path&s received a ventrodorsal opposed field irradlatlon of the lymph nodes. The llehls extended from the top of the 11th thoraclc vertebra to in Stage IL4 (lymph nodes <2 cm ) received 30 Gy, and patients with Stage IIB (lymph nodes between 2 and 5 cm) 36 Gy total dose. Resultsz 39 patients in Stage IIA and 19 patients lu Stage IIB were evaluated. After a median observatlou time of 37 months all patlents are alive and disease free. Recurrence free survival ln stage IIA was 100%. Two patients in Stage IIB experienced a recurrence 10 and 17 mouths after the end of radiotherapy. The actuarial racurrence free survival estimate in Stage IIB was 94.1% for 1 year and 87.4% for 2 years. One recurrence in Stage IIB occurred in the medlastinmn, one in the mediastinum, and one the lung. Both patients could be salvagad by chemotherapy. There were no pelvic recurrences. The treatment was well tolerated, with nausea being the most common side effect (56.9% Grade 1, 15.5% Grade 2, and 8.6% Grade 3). Diarrhea occurred in 15.5% iGrade 1), 15.5% (Grade 2), and 5.2% (Grade 3) of the patients. Conchrsmns: The outcome of para-aortlc and ipsllateral iliac irradmtion lu Stage DA/B testicular seminoma is excellent wlth the currently avalhtble staging methods and treatment facllltles. The treatment is well tolerated. The lower margin of the iliacal field can be placed at the acetabulum.