Marks L B, Anscher M S, Shipley W U
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Hematol Oncol Clin North Am. 1991 Dec;5(6):1143-72.
Infradiaphragmatic radiotherapy remains the treatment of choice for patients with stage I and II (small volume) testicular seminoma. With this approach, the disease-free survival rate exceeds 90% to 95%, and the ultimate disease-free survival rate (including salvage) is 95% to 100%. Initial therapy for patients with large-volume stage II, III, and IV disease should include multiagent systemic chemotherapy. Involved field radiotherapy is recommended for these patients following the chemotherapy, especially in patients with residual masses larger than a few centimeters. Although not used frequently in the United States, infradiaphragmatic radiotherapy is a viable treatment option for patients with clinical stage I testicular nonseminomas. Such therapy results in approximately an 85% to 90% relapse-free survival rate, with an ultimate survival rate (including salvage) approaching 100%. Initial therapy for patients with stage II or greater disease generally should include chemotherapy and/or surgery. Radiotherapy is often useful as post-chemotherapy consolidation, especially for unresectable masses. For extra-gonadal seminomas, radiotherapy is useful as definitive therapy for small-volume disease and as consolidative therapy (postchemotherapy) for more advanced disease.
膈下放疗仍然是I期和II期（小体积）睾丸精原细胞瘤患者的首选治疗方法。采用这种方法，无病生存率超过90%至95%，最终无病生存率（包括挽救性治疗）为95%至100%。对于大体积II期、III期和IV期疾病患者，初始治疗应包括多药全身化疗。化疗后建议对这些患者进行累及野放疗，尤其是对于残留肿块大于几厘米的患者。虽然在美国使用频率不高，但膈下放疗是临床I期睾丸非精原细胞瘤患者可行的治疗选择。这种治疗方法的无复发生存率约为85%至90%，最终生存率（包括挽救性治疗）接近100%。II期或更晚期疾病患者的初始治疗通常应包括化疗和/或手术。放疗作为化疗后巩固治疗通常很有用，尤其是对于不可切除的肿块。对于性腺外精原细胞瘤，放疗对于小体积疾病是有效的确定性治疗方法，对于更晚期疾病是有效的巩固治疗（化疗后）方法。
