Sommer K, Brockmann W P, Hübener K H
Department of Radiotherapy, University Hospital Hamburg-Eppendorf, West Germany.
Cancer. 1990 Jul 15;66(2):259-63. doi: 10.1002/1097-0142(19900715)66:2<259::aid-cncr2820660211>3.0.co;2-o.
From 1977 to 1988, 215 patients with a diagnosis of testicular seminoma were referred to the University Hospital, Hamburg, West Germany, for radiation therapy (RT). In 15 patients a careful review of the histologic condition showed signs of embryonal cell carcinoma. Three patients refused completion of therapy. No patient was lost to follow-up. On this basis, a retrospective review of 197 patients was carried out. One hundred thirty-three patients were classified as Stage I (67%), 39 as Stage II (20%), 8 as Stage III (4%), and 17 as Stage IV (9%). One hundred eighty patients had classic seminoma and 17 had anaplastic seminoma. All patients underwent high inguinal orchiectomy before treatment. Seven patients with Stages III and IV received chemotherapy before RT. Patients with Stages I and II were treated with 40-Gy photons to paraaortic and parailiac fields. Ten patients with Stage III and IV seminoma received 30-Gy photons to mediastinal and supraclavicular fields as well. Sixty patients received additional inguinal RT. The overall 5-year survival rate (corrected for intercurrent death, except for treatment toxicity) was 100% for Stage I, 100% for Stage II, 87% for Stage III, and 87% for Stage IV. The mean follow-up time was 6.3 years (range, 0.6 to 11.9 years). An evaluation of all patients showed no difference according to histologic condition or prior chemotherapy. Mediastinal and supraclavicular irradiation showed no improvement in treatment results. Acute toxicity consisted of mild to moderate emesis, increased bowel frequency, erythema, and, in four cases leucopenia and thrombopenia (all World Health Organization [WHO] Grades I to II). However, one patient died of a pulmonary fibrosis 1 month after mediastinal irradiation and 2 months after polychemotherapy, and a gastroduodenal ulcer developed in another patient 1.5 months after paraaortic RT and prior polychemotherapy. Overall, the data suggest that to avoid overtreatment and consecutive treatment morbidity reduced doses of 30 Gy and a restrictive treatment planning adapted to the individual risk are sufficient for RT for testicular seminoma. An alternative to postoperative RT in Stage I (and possibly Stage II) seminoma could be no RT, but close follow-up instead.
1977年至1988年期间，215例诊断为睾丸精原细胞瘤的患者被转诊至西德汉堡大学医院接受放射治疗（RT）。对15例患者的组织学状况进行仔细复查后发现有胚胎细胞癌迹象。3例患者拒绝完成治疗。无患者失访。在此基础上，对197例患者进行了回顾性研究。133例患者被归类为I期（67%），39例为II期（20%），8例为III期（4%），17例为IV期（9%）。180例患者为经典型精原细胞瘤，17例为间变型精原细胞瘤。所有患者在治疗前均接受了高位腹股沟睾丸切除术。7例III期和IV期患者在放疗前接受了化疗。I期和II期患者接受40 Gy光子束照射腹主动脉旁和髂血管旁区域。10例III期和IV期精原细胞瘤患者还接受了30 Gy光子束照射纵隔和锁骨上区域。60例患者接受了额外的腹股沟放疗。I期患者的总体5年生存率（校正并发死亡，不包括治疗毒性）为100%，II期为100%，III期为87%，IV期为87%。平均随访时间为6.3年（范围0.6至11.9年）。对所有患者的评估显示，根据组织学状况或先前化疗情况无差异。纵隔和锁骨上照射并未改善治疗效果。急性毒性包括轻度至中度呕吐、排便次数增加、红斑，4例出现白细胞减少和血小板减少（均为世界卫生组织[WHO]I至II级）。然而，1例患者在纵隔照射后1个月和多药化疗后2个月死于肺纤维化，另1例患者在腹主动脉旁放疗和先前多药化疗后1.5个月发生胃十二指肠溃疡。总体而言，数据表明，为避免过度治疗和连续治疗的并发症，对于睾丸精原细胞瘤放疗，30 Gy的降低剂量和根据个体风险调整的限制性治疗方案就足够了。I期（可能还有II期）精原细胞瘤术后放疗的替代方案可以是不放疗，而是密切随访。
