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

ABSTRACT

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