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Objective To compare the field-matching techniques and dosimetric characteristics in the target area of testicular seminoma including the abdominal and pelvic cavities between direct aperture optimization intensity modulated radiation therapy (DAO-IMRT) and 3D conformal radiation therapy (3D-CRT),and to analyse the advantages and disadvantages of DAO-IMRT.Methods DAO-IMRT and 3D-CRT plans were designed with Pinnacle treatment planning system for 7 testicular seminoma patients,and the characteristics of both the irradiation methods were analyzed and evaluated by means of the parameters like dose homogeneity indexes,dose volume histograms and etc.Results DAO-IMRT had the hot and cold volumes in the target areas both significantly smaller than those by 3D-CRT,while the conformity index and homogeneity index superior to those by 3D-CRT.The mean doses (Dmean) by DAO-IMRT of the organs at risk (OAR) except the left femur head were all lower than those by 3D-CRT,aud the V15 values of liver,double kidney,small intestine and rectum by DAO-IMRT were statistically lower than those by 3D-CRT (P＜0.01).3D-CRT had the V5 values of OAR all lower than those by DAO-IMRT,in which the differences of double kidney,small intestine,bladder,left femur head and normal tissues were significant statistically (P＜0.05).The monitor units by DAO-IMRT roughly doubled when compared with those by 3D-CRT,and the difference was also significant (P＜0.01).Conclusion DAO-IMRT with easy operation and high reliability can avoid the connection of fields in the target area of testicular seminoma,and is superior to 3D-CRT in dosimetry.
ABSTRACT
PURPOSE: To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. MATERIALS AND METHODS: Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). RESULTS: With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. CONCLUSION: Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.
Subject(s)
Adult , Humans , Male , Middle Aged , Young Adult , Disease-Free Survival , Dose Fractionation, Radiation , Follow-Up Studies , Neoplasm Recurrence, Local/pathology , Radiotherapy, Adjuvant/adverse effects , Seminoma/radiotherapy , Testicular Neoplasms/radiotherapy , Treatment OutcomeABSTRACT
Joven masculino, de la raza negra, de 41 años de edad, que en el año 1999, acude a consulta de urología del Hospital General "Abel Santamaría Cuadrado" por un aumento de volumen del testículo izquierdo, no doloroso con diagnóstico clínico e imaginológico de tumor testicular izquierdo, es ingresado en el servicio de Urología, realizándole el tratamiento quirúrgico (orquiectomia izquierda ) constatándose el resultado biópsico que reporta seminoma clásico, clasificado (T1N1M0), asociando radioterapia y quimioterapia una evolución satisfactoria. El paciente es seguido en las consultas periódicas multidisciplinarías oncourológicas, en el 2009, 10 años después refiere dolor en testículo derecho, aumento de volumen en la porción media e inferior, que se interpreta de inicio como una orquiepididimitis, recibiendo un tratamiento con antibióticos (ciprofloxacina, amoxicilina ) sin respuesta al tratamiento. Los exámenes imageneológicos USG; TAC reportan imágenes nodulares con densidades variables en relación con proceso inflamatorio o tumoral y escasas adenopatías retroperitoniales e inguinales bilaterales la mayor 13mm, por lo que se decide realizar BAFF testicular derecho, comprobándose la existencia de células malignas. Se realiza la orquiectomia derecha, con el diagnóstico histopatológico seminoma testicular clásico T1NOMO-S0 (Etapa Clínica 1A). La evolución post operatoria es satisfactoria, se indica suplemento androgénico y radioterapia 30Gy. Actualmente asintomático.
A 41 years-old, black, male patient who in 1999 attended to the urology office at "Abel Santamaria Cuadrado" University Hospital with an increase of volume in the left testis, non-painful having the clinical and imaging diagnose of left testicular tumor, the patient was admitted in the Urology Service to undergo surgical treatment (left orchiectomy), verifying by biopsy, a classic seminoma, which was classified as T1N1MO. Radiotherapy and chemotherapy was indicated showing a satisfactory progress. The patient was followed-up in periodic multidisciplinary, onco-urologic consultations. In 2009, 10 years after, the patient complained of pain in the right testis, increase of volume in the middle-inferior portion of the testis that was interpreted as a process of epididymo-orchitis, starting with antibiotics (ciprofloxacin, amoxicillin),where no-treatment response was observed. Imaging examinations showed nodular imagines with variable densities in relation to an inflammatory or tumoral process and limited retro-perineal and inguinal-bilateral adenopathies <13mm, performing a BAAF in the right testis which verified the existence of malignant cells, a right orchiectomy was carried out, pathologic findings showed a classic testicular seminoma T1NOMO-S0 (Clinical stage 1A). Post operative progress is satisfactory, indicating the treatment of androgenic supplements and y-radiotherapy (30Gy). Currently the patient is asymptomatic.
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We reviewed 82 testicular tumors (78 germ cell tumors and 4 non-germ cell tumors) from 1972 to 1991 retrospectively. Among them, the pure testicular seminomas were 27(24 typical seminoma and 3 anaplastic seminoma). The mean age at the time of diagnosis was 39.0 years(20-60). There were 15 stage I, 10 stage II and 2 stage III at the initial diagnosis. The number of patients with either present or history of cryptorchidism were 10(37.0%) and all being pathologically typical seminoma. The hCG was elevated in 30% (6/20), but either AFP(0/20) or LDH(0/8) were not elevated at all. Among the 15 stage I seminoma, 8 out of 9 cases followed-up more than 3 years were tumor free. One patient with anaplastic histology progressed at 6 month follow-up. Among the 10 cases of stage II, 7 cases were followed-up average 54.8 months. 6 out of 7 cases showed no progression and one case developed metastasis to the lung, and expired at the 13 months after initial diagnosis. In the 2 cases of stage III, patients expired each at 13 and at 18 months after initial management. The overall cumulative 5 year survival rates were 100% for stage I , 88.9% for stage II and none for stage III (p<0.05) respectively. Elevated hCG combined with history of cryptorchidism showed significant correlation with the tumor stage.
Subject(s)
Humans , Male , Cryptorchidism , Diagnosis , Follow-Up Studies , Lung , Neoplasm Metastasis , Neoplasms, Germ Cell and Embryonal , Retrospective Studies , Seminoma , Survival Rate , Testicular NeoplasmsABSTRACT
Purpose:To analyze the prognostic factors of testicular seminoma.Materials and Methods:133 patients with testicular seminoma histologically proved were treated from October, 1975 to December,1990. Most of them were firstly treated with orchiectomy and minority were treated with orchiectomy plus lymphadenectomy in abdomen cavity. All patients were treated with postoperative radiotherapy and a little part of them were combined with irregular chemotherapy. Results: The overall 5-year survival rates were:92.5(65/70) for stage Ⅰ, 52.6(10/19) for stageⅡ, 25%(4/16) for stage Ⅲ and 22.2%(2/9) for stage Ⅳ. Patients received radiation dose of 20～30Gy gave a five year survival rate of 80% which was much better than those who received radiation dose 30Gy(P
ABSTRACT
A case of 24 years old Korean soldier who seminoma of right testis was presented. Literature was also briefly reviewed.