Stage II seminoma: results of postorchiectomy irradiation

One hundred forty patients with testicular seminoma were treated at the State University of New York Health Science Center at Syracuse between 1966 and 1985. Disease was classified as stage II in 32 patients (23%): stage IIA in 21 patients and stage IIB in 11 patients. All patients underwent irradiation below the diaphragm after a radical orchiectomy, and 28 underwent planned mediastinal and supraclavicular irradiation. The median follow-up was 8 1/2 years; 24 of 32 patients have been followed up for more than 5 years. Twenty-eight patients remain alive and well; four patients died of intercurrent disease. Two patients developed a recurrent seminoma in the mediastinum; a variant lymphangiographic pattern was shown in these patients, and they were cured. A third patient developed a non-seminomatous "recurrence" in the ipsilateral, unirradiated, inguinal nodes and is well after chemotherapy.     

Radiotherapy of seminoma: small-volume irradiation at the stage pT1N0M0--prophylactic irradiation of the mediastinum

122 patients suffering from seminoma were irradiated between 1971 and 1981 at the Radiotherapy Department of the University of Munich. 113 patients were available for retrospective analysis. The ten year actuarial survival for all patients was 93%. The survival rate in stage pT1N0M0 (UICC classification) was 100%, in stage pT2-4-xN0M0 97%, in stage pT1-4-xN1-3M0 93%, and in stage pT1-xN4M0/pT1-xN1-4M1 69%. Using a stage adapted target volume, the exclusive irradiation of the paraaortic nodes in the stage pT1N0M0 led to a cure-rate of 100%. Because of this result, and due to the improved tolerance and lower exposure to the remaining testis we recommend this method. The effectiveness of radiotherapy, also in advanced seminomas, the benefit of prophylactic mediastinal irradiation and the therapeutic modalities for treatment of extragonadal seminomas are discussed.     

The effect of radiotherapy treatment changes on sites of relapse in stage I testicular seminoma

AIM: To evaluate relapse patterns in stage I testicular seminoma related to changes in radiotherapy practice.METHOD: Four hundred and six patients with stage I testicular seminoma were treated with adjuvant radiotherapy following orchidectomy: 338 patients received para-aortic radiotherapy only and 68 patients with added risk factors had radiotherapy extended to include the pelvis. Computed tomograms of relapsed patients were reviewed and sites of relapse were documented with correlation to the radiotherapy field. RESULTS: Thirteen relapses were identified; 10 occurring in the para-aortic radiotherapy group (3.0% relapse rate) and three in the extended radiotherapy field group (4.4% relapse rate). Sites of relapse were; five pelvis, three mediastinum, one lung, one scapula, one scrotum, while one patient had multiple relapse sites including the pelvis and one had a tumour marker relapse with no site identified. All the pelvic relapses occurred in the para-aortic radiotherapy group. CONCLUSION: Pelvic relapse only occurred when radiotherapy had been confined to the para-aortic region. Since para-aortic radiotherapy achieves equivalent outcome to wider field radiotherapy with reduced toxicity, it is likely to become standard practice in stage I seminoma and pelvic relapses will therefore increase in frequency. It is therefore important to include pelvic imaging when relapse is suspected.     

Successful treatment of seminoma metastases using partial irradiation

A patient suffering from pulmonary metastases of a seminoma of the testicle was treated by subtotal-body irradiation with single doses of 15 cGy and a total dose of 1155 cGy. A complete remission lasting more than one year was achieved. This therapy method is recommended for the treatment of the advanced seminoma (hematogenic metastases, extension beyond the diaphragm, or regional lymph node metastases with a size of more than 5 cm) because of its lower acute toxicity.     

Long-term results of radiotherapy in stage I.II glottic carcinoma]

From 1965 to 1987, 271 patients were treated. Two hundred and sixty-two were male, and 9 were female. Age ranged from 36 to 91 years with a median value of 62 years. According to the UICC classification in 1987, 149 were T1a, 56 were T1b, 66 were T2. T2 was divided into T2a (with normal cord mobility), and T2b (with impaired cord mobility). Forty-seven were T2a and 19 were T2b. Total dose ranged from 24 to 84 Gy, and 245 received 60 Gy or more. Daily dose was 2 Gy in 249, and 3 Gy in 22. Field size ranged from 10 to 117 cm2. All 271 patients were treated with 6-MV X-ray. Adjuvant chemotherapy was performed in 91 patients. Follow-up was complete in 269 of 271 patients (99%). Eighty-four patients died of intercurrent disease. Thirty out of 84 (36%) died of second malignancy. A 10-year overall survival rate in 271 patients was 64% and a 10-year cause-specific survival rate (CSSR) was 92%. Ten-year CSSR were 94% in T1a, 92% in T1b, 90% in T2a, and 80% in T2b. Five-year local control rates were 87%, 77%, 84%, and 68%, respectively. Five patients relapsed after 5 years. Ten-year local control rates were 85%, 74%, 80%, and 68%, respectively. There seemed to be no relationship between local control rates and total dose, field size, TDF, and use of chemotherapy. Daily doses of more than 3 Gy seemed to increase complication rates.(ABSTRACT TRUNCATED AT 250 WORDS)     

CT evaluation of advanced seminoma treated with chemotherapy

The serial CT characteristics of nodal metastases from pure seminoma treated with chemotherapy were evaluated in 18 patients. Fifty percent of masses at presentation contained areas of low attenuation; none had calcification. After chemotherapy, masses completely resolved in four patients, partially resolved in 12 patients, and remained unchanged in one patient. The remaining patient developed progressive liver metastases during therapy and died. Pathologic evaluation of residual masses in four patients demonstrated only fibrosis. Residual masses in nine other patients demonstrated further partial resolution or remained stable over the following year; two developed calcification. These patients exhibited no clinical evidence of disease for a median follow-up of 22 or more months. Persistent but stable or resolving masses are common after chemotherapy for advanced seminoma. Unlike their nonseminomatous counterparts, they most often represent fibrosis in patients with no other clinical evidence of disease and do not warrant surgical excision.     

Single inguinal node metastasis of stage I testicular seminoma shown by scrotal scintigraphy, 6 months following radical orchiectomy

Lymphatic drainage of the testes is known to follow a predictable pathway that usually involves the retroperitoneal, paraaortic, paracaval and interaortocaval nodal chains. Herein we report the case of a 41 years old man with a stage I testicular seminoma, with an unexpected inguinal lymph node metastasis. During his routine follow-up visit, 6 months after radical orchiectomy, a spherical mass in the right inguinal region was palpated. Thoraco-abdominal CT did not reveal any evidence of retroperitoneal enlarged lymph nodes or distant metastases, but showed a 2cm right inguinal mass. Scrotal scintigraphy with technetium-99m pertechnetate was performed in order to evaluate the local vascularity of the right inguinal area. The angiographic phase (0-1min) and the blood pool images at 15, 30, 45 and 60min revealed high uptake in the right inguinal region, suggesting a hyperemic mass suspicious for tumor recurrence. The excised mass was found to be an enlarged lymph node infiltrated with seminoma. The patient received adjuvant radiotherapy to which he showed a complete response and has been disease free at 2 years follow-up. In conclusion, in the case presented scrotal scintigraphy showed a hyperemic mass at the right inguinal region that proved to be the sentinel node of a stage I testicular seminoma and was treated accordingly.     

'Watch policy' in patients with suspected stage I testicular seminoma: CT as a sole staging and surveillance technique

A study was undertaken to assess the role of computed tomography (CT) as the sole imaging technique for the staging and surveillance of patients with stage I testicular seminoma. Of the 15 patients studied, five (33%) relapsed. This relapse rate differs from other studies. The reasons for this are discussed.     

Stage I seminoma in a 15-year-old boy

Seminomas are very rare tumours in children and adolescents. We describe a case of seminoma in a 15-year-old boy who was managed with orchidectomy but no adjuvant therapy. He remains relapse-free 8 years after surgery as determined by clinical, radiological and serological surveillance. This study emphasizes the uncertainty over the need for adjuvant treatment in the management of seminoma in the adolescent patient, in particular in prepubescent children.     

Optimal thoracic irradiation for stage IV lung cancer

To investigate optimal thoracic irradiation (TI) for stage IV lung cancer, we retrospectively reviewed 150 patients. In all, 101 patients underwent radiotherapy for the primary lesion, and 130 had radiotherapy for metastasized sites. TI fields were basically divided into two groups; whole thoracic lesion irradiation (WTLI) and partial thoracic lesion irradiation (PTLI). Overall survival rates at 6 months, 1 year and 2 years were 58%, 27% and 11%, respectively, and MST was 7.1 months. There was no difference in survival according to histological type. On univariate analysis, the factors of good prognosis included good PS, free of bone metastasis, metastasis limited to a single organ, TI, chemotherapy, age (less than or equal to 75 years), and TN factors (T0-2 and N0-1). Multivariate analysis showed PS was the predominant factor. Among the patients treated with TI, survival rates of patients with PS 0-1 were superior to those of patients with PS 2-4. Radiation pneumonitis was more frequent in WTLI than in PTLI. The rates of thoracic failure death were 31.7% in patients treated with TI and 63.3% without TI. However, the size of the thoracic radiation field did not affect the rates of thoracic failure death. We concluded that TI for stage IV patients could reduce thoracic symptoms and increase the survival rate in the subgroup with good PS. Furthermore, we considered PTLI was worth while in the subgroup with poor PS.     

辐射导致长期骨髓抑制的研究进展

随着接受放疗患者生存期的延长,患者发生长期骨髓抑制的概率也大幅提高。长期骨髓抑制在临床中常被忽略,随着时间延长患者病情会逐渐加重,生活质量降低。许多长期骨髓抑制患者会形成再生障碍性贫血或者骨髓增生异常综合征,严重者可引发死亡。研究资料表明,活性氧和丝裂原活化蛋白激酶p38（P38MAPK）通路在辐射诱导长期骨髓抑制中占主要作用。笔者总结了辐射导致的长期骨髓抑制的相关研究,指出了今后的研究方向。     

Significance of postoperative irradiation for stage III lung cancer

The significance of postoperative irradiation for stage III lung cancer was analyzed in 30 patients. Radiation was given to 15 of the patients and the remaining 15 did not receive any radiation therapy following surgical intervention. A total dose of 40 to 70 Gy was given to the radiation group with a fraction dose of 2 Gy five times a week using cobalt 60 gamma-ray or linac 10 MV X-ray. There was no significant difference of survival time between these two groups. However, in analyzing modes of operation, radiation seemed to improve the survival rate in patients who underwent curative or relatively curative operations (P = 0.1), while the patients who underwent non-curative operations did not receive any benefit from the postoperative irradiation. Some reasons for the ineffectiveness in cases of non-curative operation are discussed.     

The role of postoperative irradiation in the management of stage I adenocarcinoma of the endometrium.

A comparison of treatment protocols for endometrial carcinoma is presented. Valid conclusions regarding optimum approach are virtually precluded because of variability of such factors as clinical staging, incidence of vaginal metastases, patient selection, and histologic grade. While hysterectomy is the established definitive treatement, the superiority of adjuvant irradiation can be demonstrated only by randomized prospective studies.     

Management preferences following radical inguinal orchidectomy for Stage I testicular seminoma in Australasia

A survey to evaluate the preferred patterns of management of Stage I seminoma was conducted during March 2001. The questionnaire was distributed by the Royal Australian and New Zealand College of Radiologists to all qualified radiation oncologists, 74 out of 170 responded. All performed a staging CT scan of the abdomen and pelvis. Thoracic imaging consisted of either chest X-ray (29%) or chest CT (38%) while 33% performed both. Fifty-four percent of radiation oncologists discussed surveillance with their patients but estimated that 5% or less would choose this option. The most commonly prescribed dose was 25 Gy in 15 or 20 fractions (79%). Sixty-five percent of respondents treated the para-aortic (PA) nodes alone. Forty-two of 48 clinicians treating the PA field reported a change in practice after publication of the Medical Research Council study in 1999. Of these, 40 and 23% perform CT scans of the pelvis annually and every 6 months. Thirty-one percent did no follow-up CT scan. Compared to a similar survey from North America, we are more likely to use PA fields and less likely to discuss surveillance. As in the USA, and in contrast to Canada, few patients choose surveillance. There is no consensus regarding the frequency of follow-up scans in either North America or Australasia.     

Dose outside the treatment field for external irradiation with high-energy X-ray reduction of the dose of the remaining testis in postoperative irradiation of seminoma

This study aimed to decrease the radiation dose to the disease-free testis in postoperative irradiation for seminoma patients. We consider the factors influencing the peripheral dose (PD) of 10MV X-ray radiotherapy to be the distance between the caudal edge of the irradiation field and the measuring point, the size of the therapeutic irradiation field, the thickness of the lead shield laid above and lateral to the disease-free testis, and the thickness of the lateral absorber. Materials and methods: We measured the scattering radiation dose coming from the accelerator head and that due to irradiation volume. We measured these doses using a testicular phantom as the non-diseased testis.Results: Scattering radiation from the accelerator head mainly contributes to PD, whereas the larger the size of the irradiation field the more the scattering radiation from the irradiation volume contributed to PD. PD changed more at the surface of the phantom than at its center. PD at the testicular phantom could be reduced to less than 1% of the therapeutic dose when it was situated more than 5cm distant from the caudal limit of the irradiation field, the lead shield above the testicular phantom was 7.5cm thick, and the lateral lead shield was 2mm thick.Conclusions: PD is influenced by many factors. It is necessary to clarify the change in PD at the testicular phantom, and it is important to limit the caudal edge of the irradiation field and to lay the lead shield for the attenuation of radiation on the disease-free testis.     

Long-term results of multicatheter interstitial high-dose-rate brachytherapy for accelerated partial-breast irradiation

Purpose

The purpose of this study was to report the long-term results of women treated in one center with accelerated partial-breast irradiation (APBI) with interstitial high-dose-rate (HDR) brachytherapy.

Treatment of subdiaphragmatic lymph node metastases of primary testicular seminoma (stage II)

From January 1968 through December 1985, 123 patients with subdiaphragmatic lymph node metastases from testicular seminoma were observed. Eighty-five patients presented with metastases not bigger than 5 cm (stage II low), and they were all treated with radiotherapy (target dose: 35-45 Gy). Out of 38 patients with advanced retroperitoneal disease (because of metastases bigger than 5 cm: stage II, bulky), 18 were treated with radiotherapy, 14 with chemotherapy, and 6 with combined radiotherapy and chemotherapy; moreover, 14 out of 38 patients underwent surgical treatment (whole/partial lymph node resection). Actuarial relapse-free survival rate has proven higher for "low" patients than for "bulky" ones, both at 5 years (85.4% versus 75.8%) and at 10 years (83.5% versus 75.8%). On the contrary, overall survival has been higher for "low" patients at short-term follow-up only (90.4% vs 83.9% at 5 years), while long-term follow-up (10 years) has proven the same in both groups. Relapses (22 cases) occurred within 2 years in 75% of cases, and within 3 years in 90%. Overall incidence of lymph node recurrence has been 10.6%, higher in "bulky" patients (13.3% if treated with radiotherapy alone and 21.4% if treated with chemotherapy and/or surgery). Distant metastases occurred in 8.1% of cases. Long-term salvage treatment by chemotherapy was performed on 1/13 failures in stage II "low" patients and in 3/9 failures in stage II "bulky" patients. Four patients underwent effective salvage therapy in the "low" group, 3 by radiotherapy and 1 by surgery. The authors stress how curative radiotherapy appears to be the best treatment for retroperitoneal lymph node metastases less than 5 cm diameter, while chemotherapy is still to be demonstrated to yield better results than radiotherapy as first treatment for patients with advanced abdominal disease.