Detti Beatrice, Scoccianti Silvia, Villari Donata, Cipressi Samantha, Sardaro Angela, Simontacchi Gabriele, Livi Lorenzo, Gacci Mauro, Cai Tommaso, Greto Daniela, Desideri Isacco, Biti Giampaolo
Radiotherapy Unit, Azienda Ospedaliero-Universitaria Careggi, Italy.
Onkologie. 2011;34(10):510-4. doi: 10.1159/000332124. Epub 2011 Sep 19.
The aim of this study was to review the treatment, toxicity, and outcomes in patients with stage I seminoma after orchidectomy.
A retrospective chart review of all patients with stage I seminoma referred for initial treatment during the last 49 years was performed. Initial treatment approaches, toxicity, and outcomes were analyzed.
A total of 320 patients were seen between 1960 and 2009. Median age at diagnosis was 37 years (range: 20-72), with a median follow-up of 22.7 years (range: 1-48). All patients but 12 were treated with adjuvant radiotherapy. Acute toxicity was mainly gastrointestinal, with 7.6% classified as grade 2. The 10-year disease-specific survival and relapse-free survival were 97.7 and 97.6%, respectively. 8 patients (2.7%) developed a relapse and were managed with chemotherapy. 10 patients died, 6 of the disease and 4 from other causes (disease-free at time of death).
In the management of stage I seminoma, 3 treatment options are available; currently in the European Consensus, surveillance is the first choice, considering the overall comparable outcome and the low acute and late toxicity. Adjuvant radiotherapy and adjuvant chemotherapy should be considered as alternative options only if the patient declines the surveillance strategy.
本研究旨在回顾睾丸切除术后I期精原细胞瘤患者的治疗、毒性反应及预后情况。
对过去49年间所有因初始治疗而转诊的I期精原细胞瘤患者进行回顾性病历审查。分析初始治疗方法、毒性反应及预后情况。
1960年至2009年间共诊治320例患者。诊断时的中位年龄为37岁（范围：20 - 72岁），中位随访时间为22.7年（范围：1 - 48年）。除12例患者外，所有患者均接受了辅助放疗。急性毒性反应主要为胃肠道反应，7.6%的患者为2级。10年疾病特异性生存率和无复发生存率分别为97.7%和97.6%。8例患者（2.7%）出现复发，接受了化疗。10例患者死亡，6例死于疾病，4例死于其他原因（死亡时无疾病）。
在I期精原细胞瘤的治疗中，有3种治疗选择；目前在欧洲共识中，考虑到总体预后相当以及急性和晚期毒性较低，监测是首选。仅当患者拒绝监测策略时，辅助放疗和辅助化疗才应被视为替代选择。
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