Although radiotherapy is frequently used as adjuvant therapy after orchiectomy for stage I disease or used in the active treatment of small-volume stage II (A to B) seminoma, there are situations in which there may be absolute or relative contraindications

to its use. Contraindications to radiotherapy may occur with the following:

1. A displaced or rotated position of the left kidney, which may alter the lymphatic drainage

2. Inflammatory diseases of the abdomen (regional ileitis, pancreatitis, gastroduodenal ulcer, diverticulitis, hepatitis)

3. Morbid obesity

4. Abdomino-pelvic adhesions

5. Acquired immunodeficiency syndrome (AIDS) with a low CD4 count

6. Extragonadal seminoma (large size)

7. Horseshoe or pelvic kidney (in the field of irradiation)

8. Patient refusal

In these situations, the clinician should discuss the treatment options with the patient, and the clinical setting will govern whether adjuvant radiotherapy is used or whether (for defined lymph node metastases) chemotherapy is administered as an alternative. The situation for the patient with AIDS and a low CD4 count is particularly difficult, and once again, the clinical situation will usually govern the decision process.

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