Results Of Studies

A review of 2,558 patients irradiated for stage I seminoma revealed a long-term survival rate of 96 to

100%, with a 0 to 10% relapse rate. Surveillance of 727 patients with stage I disease showed a median relapse rate of 13%, with a 100% survival rate13 (see Chapter 18 for a detailed discussion). A review of survival rates in 469 patients with stage II disease treated with irradiation only (nodes < 5 cm in diameter) demonstrated a survival rate of 85 to 100%; for 189 patients with stage II disease with nodes > 5 cm, the survival rate was 60 to 80%.14 In this series, medi-astinal and supraclavicular irradiation was commonly employed in these patients with stage II seminoma. Relapse rates in patients treated with and without retroperitoneal irradiation from Christie Hospital, Princess Margaret Hospital, and Aarhus University Hospital are shown in Tables 19-1 and 19-2. In general, when patients treated with radiotherapy experience recurrence, it is usually in the mediastinum; by contrast, in unirradiated patients, relapses that occur are usually found in the para-aortic region. In 49 irradiated patients with stage II disease, the relapse rate was 4% for those with para-aortic nodes < 5 cm and 33% for those with nodes >10 cm. In a review of 148 patients with seminomatous bulk > 10 cm, treated with irradiation only, the survival rates ranged from 33 to 70% whereas the rates were 80 to 100% for patients with bulk <10 cm.15 As the size of the para-aortic mass increases, the ability to control it with radiation decreases.

Before the era of precise tumor markers, an autopsy review of 154 patients with pure seminoma

Table 19-2. RELAPSE IN STAGE I PATIENTS UNDERGOING SURVEILLANCE

Stage

Recurrences/ Total Patients

Supraclavicular/ Mediastinal

Region of Recurrence

Para-aortic

Groin

Lung

Other

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