Niewald Marcus, Freyd Johanna, Fleckenstein Jochen, Wullich Bernd, Rübe Christian
Department of Radiooncology, Saarland University Hospital, Homburg, Germany.
Int J Radiat Oncol Biol Phys. 2006 Nov 15;66(4):1112-9. doi: 10.1016/j.ijrobp.2006.06.054. Epub 2006 Sep 18.
The aim of this study was to review retrospectively the results of low-dose radiotherapy for Stage I seminoma using four different fractionation schedules and target volume definitions.
A total of 191 patients underwent irradiation for histologically proven Stage I seminoma after undergoing an inguinal orchiectomy. Fractionation schedules were used one after another as follows: Total dose 30 Gy (dose/fraction 1.5 Gy, 16 patients), total dose 25.5 Gy (dose/fraction 1.5 Gy, 62 patients), total dose 20 Gy (dose/fraction 2 Gy, 69 patients), total dose 26 Gy (dose/fraction 2 Gy, 29 patients). The remaining 12 patients were excluded from this study. In the same period the target volume was gradually reduced. In 1983 the paraaortic, pelvic and inguinal regions were irradiated; later the target volume was reduced to the paraaortic region exclusively.
Overall survival and event-free survival were identical in all groups ranging from 95% to 100% /5 years. Three patients experienced a lymph node metastasis during follow-up, 3 patients a distant metastasis to the lung and the bones. Mild acute side effects were noted in 8% to 15% of the patients, and very mild long-term side effects in 1% to 5% of patients. Multivariate analysis showed no prognostic significance of total dose, dose per fraction, or target volume. In univariate analysis, a higher frequency of acute side effects to the skin and the bowel was related to a higher total dose, and an elevated frequency of nausea was related to a higher daily dose per fraction.
Using lower doses and limiting the target volume to the paraaortic region exclusively did not result in a worse prognosis in our patient series.
本研究的目的是回顾性分析采用四种不同分割方案和靶区定义对Ⅰ期精原细胞瘤进行低剂量放疗的结果。
共有191例经腹股沟睾丸切除术后组织学确诊为Ⅰ期精原细胞瘤的患者接受了放疗。分割方案依次如下：总剂量30 Gy（每次分割剂量1.5 Gy，16例患者），总剂量25.5 Gy（每次分割剂量1.5 Gy，62例患者），总剂量20 Gy（每次分割剂量2 Gy，69例患者），总剂量26 Gy（每次分割剂量2 Gy，29例患者）。其余12例患者被排除在本研究之外。同期靶区逐渐缩小。1983年对腹主动脉旁、盆腔和腹股沟区进行照射；后来靶区仅缩小至腹主动脉旁区域。
所有组的总生存率和无事件生存率相同，5年生存率在95%至100%之间。3例患者在随访期间发生淋巴结转移，3例患者发生肺和骨远处转移。8%至15%的患者出现轻度急性副作用，1%至5%的患者出现非常轻微的长期副作用。多因素分析显示总剂量、每次分割剂量或靶区无预后意义。单因素分析显示，皮肤和肠道急性副作用发生率较高与总剂量较高有关，恶心发生率升高与每次分割日剂量较高有关。
在我们的患者系列中，使用较低剂量并仅将靶区限制在腹主动脉旁区域并未导致更差的预后。
