Adjuvant radiotherapy for synchronous bilateral testicular seminoma: a case report and a review of the pertinent literature.

Few cases of synchronous bilateral stage I seminomas have been reported in the world literature. We present a case of bilateral synchronous testicular seminoma, the current literature on the management of stage I seminoma, and the implications for radiotherapy. A forty-year-old man presented with synchronous bilateral classical seminomas, both stage IA. After undergoing bilateral inguinal orchiectomy, he received adjuvant external beam radiotherapy, with a standard paraaortic field. After 18 months of followup, he remains well, without evidence of recurrence. Bilateral germ cell tumors (BGCTs) are reported consistently at a low rate. Bilateral radical inguinal orchiectomy is standard of care, yet some groups have proposed an organ preservation approach. Of the reported cases of bilateral stage I synchronous GCT, with concordant seminoma histology, most of them were treated with bilateral orchiectomy and adjuvant radiotherapy. Although morbidity associated with radiotherapy directed at the abdomen is not negligible, adjuvant paraaortic radiotherapy remains safe and well-tolerated treatment regime. Bilateral synchronous stage I seminoma of the testes is rare. Organ preservation remains investigational. Chemotherapy is probably a reasonable option. We propose that patients with bilateral stage I synchronous GCT, with concordant seminoma histology, should be managed with bilateral orchiectomy, followed by paraaortic radiotherapy.

Lung reirradiation with stereotactic body radiotherapy (SBRT).

INTRODUCTION: There is limited data on the use of SBRT in reirradiation of lung tumors. We reviewed outcomes following SBRT after previous thoracic radiotherapy at the University of Minnesota Medical Center. METHODS: From August 2006 through October 2012, fourteen lung tumors in thirteen patients with either biopsy confirmed or presumed non-small cell lung cancer in patients who were medically unable to undergo biopsy, were retreated with SBRT. Eligible patient charts were reviewed to evaluate survival, recurrence patterns and toxicity following reirradiation. RESULTS: The median age of patients at the time of SBRT was 67.9 years. The median duration of follow-up was 11.4 months. Ten patients received prior conventional thoracic irradiation (median dose 6120 cGy). Two patients received prior SBRT with curative intent. The median time to reirradiation with SBRT was 19.7 months. Following reirradiation with SBRT, four patients (33%) are alive and disease free. Eight patients (67%) experienced progressive disease. There were five distant and two regional recurrences. There was one isolated local recurrence. Local control was 92% with a median survival of 24 months (95% CI: 8-38 months). 1- and 2-year overall survival were 80% (95% CI: 41%-95%) and 36% (95% CI: 6%-68%) respectively. There was one grade 2 and one grade 3 toxicity. No grade 4 or 5 toxicities were seen. CONCLUSIONS: SBRT is a reasonable salvage therapy for lung tumor recurrence or second primary lung malignancy in patients previously treated with thoracic radiotherapy, offering good local control and resulting in acceptable toxicity. Further evaluation of this treatment option is warranted.