The Princess Margaret Hospital Experience in the Management of Stage I and II Seminoma — 1981 to 1991

Publisher Summary This chapter discusses recent results in stage I and II seminoma at Princess Margaret Hospital (PMH) with emphasis on the impact of surveillance in stage I and chemotherapy in stage II disease. Between 1981 and 1991 inclusive, 456 patients with seminoma were managed at the PMH. Patients were referred to the PMH after initial orchiectomy and investigated with chest X-ray, bipedal lymph angiogram (LAG), and/or CT scan of the abdomen and pelvis. Since 1984, 148 patients with stage I seminoma have been entered on a prospective nonrandomized trial of surveillance. Assessment of stage II patients for response to treatment is difficult as the retroperitoneal adenopathy, especially when bulky, may regress slowly following therapy. Survival and relapse rate were calculated from the date of diagnosis. The five year overall actuarial survival for the combined stage I and II groups was 96% and the cause specific survival (CSS) was 98%. The overall results of treatment in stage I and II seminoma are very gratifying. With excellent results, minimal toxicity, and only a small risk of second cancers, there is reluctance to reassess the role of routine postoperative RT in stage I seminoma.