Epstein B E, Order S E, Zinreich E S
Johns Hopkins Oncology Center, Division of Radiation Oncology, Baltimore, MD 21205.
Cancer. 1990 Feb 1;65(3):405-11. doi: 10.1002/1097-0142(19900201)65:3<405::aid-cncr2820650305>3.0.co;2-#.
Sixty-one patients with histologically confirmed seminoma of the testis were treated by radiotherapy at The Johns Hopkins Hospital from 1975 to 1987. Fifty-seven patients remain disease-free, three patients died of intercurrent disease, and one patient (Stage IIB) died of widespread seminoma. Median follow-up for these patients is 5.5 years. Using a modified M.D. Anderson Hospital clinical staging system, 42 (69%) were Stage I, 16 (26%) were Stage IIA, and three (5%) were Stage IIB. Radiologic staging included both lymphangiogram (LAG) and abdominal computed tomography (CT) scan. Among Stage I disease, nine patients had false-positive CT scans, determined by negative LAG. Six patients had false-negative CT scans and were upstaged to Stage IIA by LAG. Treatment portals were altered in 15 of the 39 patients (38%) who had both LAG and CT scan. Overall actuarial survival (Kaplan-Meier method) was 97% at 5 years and 92% at 10 years. Five-year survival corrected for intercurrent disease was 100% for Stage I, 100% for Stage IIA, and two of three in Stage IIB patients. There were two distant treatment failures among the entire cohort. One patient who had Stage I disease was salvaged with local-field radiation and chemotherapy and is now without evidence of disease for 6 years. The second patient with Stage IIB seminoma receiving the same treatments disseminated and died. There were no significant acute toxicities or serious complications. In summary, proper staging with information gained from LAG and adequate radiation dose led to a 92% 10-year disease-free survival.
1975年至1987年期间，约翰·霍普金斯医院对61例经组织学确诊为睾丸精原细胞瘤的患者进行了放射治疗。57例患者仍无疾病，3例患者死于并发疾病，1例患者（IIB期）死于广泛播散的精原细胞瘤。这些患者的中位随访时间为5.5年。采用改良的MD安德森医院临床分期系统，42例（69%）为I期，16例（26%）为IIA期，3例（5%）为IIB期。放射学分期包括淋巴管造影（LAG）和腹部计算机断层扫描（CT）。在I期疾病中，9例患者CT扫描结果为假阳性，经LAG检查为阴性。6例患者CT扫描结果为假阴性，经LAG检查被上调至IIA期。在39例同时进行LAG和CT扫描的患者中，15例（38%）的治疗野发生了改变。总体精算生存率（Kaplan-Meier法）5年时为97%，10年时为92%。I期患者经并发疾病校正后的5年生存率为100%，IIA期为100%，IIB期患者中3例中有2例。整个队列中有2例远处治疗失败。1例I期疾病患者通过局部野放疗和化疗挽救成功，目前已无疾病证据6年。第2例IIB期精原细胞瘤患者接受相同治疗后发生播散并死亡。没有明显的急性毒性反应或严重并发症。总之，通过LAG获得的信息进行准确分期和给予足够的放射剂量，使得10年无病生存率达到92%。
