Short course of para-aortic irradiation for patients with stage I seminoma of the testis

Adjuvant postoperative para-aortic lymph nodal irradiation is an acceptable alternative to para-aortic and ipsilateral pelvic irradiation post-orchiectomy for patients with stage I seminoma of the testis. In this article, we report the results of retro-spective evaluation of para-aortic irradiation only for such patients. In a private hospital between June 1995 and June 2006, 23 patients with Stage I seminoma were treated with adjuvant irradiation to the para-aortic region only after radical inguinal orchiectomy. Radiotherapy was delivered using parallel-opposed fields extending from T11 to L4. A total dose of 25-30 Gy in 15 fractions was prescribed to midpoint. Follow-up was performed every 3 months for the first year, every 4 months for the second and third years, every 6 months for the fourth and fifth years, and annually thereafter. Chest X-ray, lactate dehydrogenase, tumor markers, and computed tomography scan of the pelvis were performed routinely as part of the follow-up investigations. At a median follow-up of 39 months, all patients arc alive and free of relapse. The actuarial 5-year relapse free survival is 100%. No late toxicity has been encountered. None had developed second malignany during the follow-up period. Patients with Stage I seminoma of the testis may be safely treated with para-aortic radiotherapy only. Risk of pelvic failure is very low and treatment toxicity minimal

Metastasis to the thyroid gland; unusual site of metastasis

The incidence of metastasis to the thyroid gland in autopsy series varies from 1.25% to 24%. Metastasis to the thyroid gland is usually considered as a terminal event, and the effectiveness of conventional treatment has been questioned. Seven patients with metastasis to the thyroid gland were studied retrospectively. Primary tumor origin was identified in all of them. Metastasis to the thyroid gland was confirmed by fine needle aspiration cytology or histology. Data were analyzed for the type of malignant lesions, the clinical course of the disease, and the prognosis after thyroid involvement. Two patients had lung as a primary tumor site. Breast, iris, kidney, parotid and soft tissue sarcoma were the involved primary sites in the other cases. The time from the diagnosis of primary tumor to metastasis to the thyroid gland was considerable [ranged from 13-135 months, median 60 months]. Fine needle aspiration cytology detected metastasis in five of seven patients. Treatment was surgery alone or surgery with adjuvant therapy. One patient didn't receive any treatment. In any patient with a previous history of malignancy, no matter how old that history is a new thyroid mass should be considered as recurrence until proved otherwise. Although detection of metastasis to the thyroid gland often indicates poor prognosis, aggressive surgical and medical therapy may be effective in a small percentage of patients