[Treatment options in early-stage testicular seminoma. Review of the literature with initial results of a prospective multicenter study on radiotherapy of clinical-stage I, IIA and IIB seminomas].

BACKGROUND: Testicular seminoma in the early stages is treated with orchiectomy and radiotherapy to the retroperitoneal nodes. Despite the high cure rates of this treatment, there is an ongoing controversy concerning the extent of the radiation fields and the radiation doses to be given in the clinical stages I, IIA and IIB. In the following literature review, these controversial issues are discussed. Recent reports emphasize, that the irradiation of the paraaortic nodes seems to be adequate in stage I disease. The "wait and see" strategy avoids an overtreatment in 80% of the patients in stage I. The application of 1 or 2 cycles of carboplatinum chemotherapy induced comparable results to adjuvant radiotherapy. In the stages IIA and IIB radiotherapy to the paraaortal and ipsilateral iliacal nodes, with a prescribed dose of 30 Gy and 36 Gy respectively, has been the standard treatment. The treatment of the upper contralateral iliacal nodes has been a matter of controversy. PATIENTS AND METHODS: Four hundred and ninety-one patients in stage I testicular seminoma received adjuvant paraaortic irradiation with a total dose of 26 Gy. Forty-one patients in stage IIA, and 19 patients in stage IIB received 30 Gy or 36 Gy respectively to the paraaortic and ipsilateral iliacal nodes. RESULTS: Paraaortic radiotherapy in stage I disease was associated with low acute side effects and a disease-free survival in 97.1% of the patients after a median observation of 13 months. In stage IIA the disease-free survival was 100%, in stage IIB 94.7%. CONCLUSIONS: The literature review and preliminary results of the reported ongoing trial are indicating that paraaortic irradiation in stage I and paraaortic with ipsilateral iliacal irradiation in stages IIA and IIB seem to be a sufficient treatment in early stage testicular seminoma with low treatment associated morbidity.