Classen J, Souchon R, Hehr T, Bamberg M
Department of Radiation Oncology, Tübingen University, Germany.
J Cancer Res Clin Oncol. 2001 Aug;127(8):475-81. doi: 10.1007/s004320100243.
Stage I and IIA/B testicular seminoma represent approximately 45% of all testicular germ cell tumours. Due to the availability of highly efficient salvage treatment, the disease-specific survival in stage I seminoma is approximately 100%, irrespective of the choice of adjuvant treatment. Radiotherapy with 26 Gy to the paraaortic/paracaval lymph nodes yields excellent cure rates of 95 98% with a favourable profile of acute and late toxicity. Likewise, phase-II trials with single-agent carboplatinum systemic treatment have demonstrated a rate of relapse of 3-4% on average. However, carboplatinum chemotherapy has to be regarded as experimental until data of phase-III trials are available. Surveillance in stage I disease is conflicted with a rate of relapse of approximately 20%. However, 80% of the patients will avoid potentially toxic overtreatment by the watch-and-wait policy. In stage IIA/B seminoma, "dogleg" radiotherapy with 30 Gy and 36 Gy, respectively, provides high cure rates of 90-95%. Those patients relapsing will be salvaged in almost 100% of cases. Testicular intraepithelial neoplasia (TIN) is the common precursor lesion of testicular germ cell tumours except for spermatocytic seminoma. In case of TIN in a single testis or bilateral TIN, local radiotherapy with 18 Gy is recommended as standard treatment.
I期和IIA/B期睾丸精原细胞瘤约占所有睾丸生殖细胞肿瘤的45%。由于有高效的挽救治疗方法，I期精原细胞瘤的疾病特异性生存率约为100%，无论辅助治疗的选择如何。对腹主动脉旁/腔静脉旁淋巴结进行26 Gy的放疗，治愈率高达95%至98%，急性和晚期毒性反应较轻。同样，单药卡铂全身治疗的II期试验表明，平均复发率为3%至4%。然而，在III期试验数据可用之前，卡铂化疗仍被视为试验性治疗。I期疾病的监测存在争议，复发率约为20%。然而，80%的患者将通过观察等待策略避免潜在的过度治疗。在IIA/B期精原细胞瘤中，分别给予30 Gy和36 Gy的“狗腿野”放疗，治愈率高达90%至95%。复发的患者几乎100%能得到挽救。睾丸上皮内瘤变（TIN）是除精母细胞性精原细胞瘤外的睾丸生殖细胞肿瘤的常见前驱病变。对于单侧睾丸TIN或双侧TIN，推荐18 Gy的局部放疗作为标准治疗。
