Lederman G S, Herman T S, Jochelson M, Silver B J, Chaffey J T, Garnick M B, Richie J, Sheldon T A, Coleman C N
Department of Radiation Therapy, Harvard Medical School, Boston, MA 02115.
Radiother Oncol. 1989 Mar;14(3):203-8. doi: 10.1016/0167-8140(89)90168-0.
One hundred and sixteen patients with stage I and II primary testicular seminoma were treated at the Joint Center for Radiation Therapy (JCRT) between 1968 and 1984. Complete follow-up is available for 114 patients (98%) with a median follow-up time of 6 years. Actuarial relapse-free survival (RFS) and survival for the entire group at 10 years were 94 and 86%, respectively, with 27 patients still at risk beyond 10 years. Actuarial RFS and survival at 10 years by stage were 97 and 92% for stage I, 93 and 81% for stage IIa, 100 and 100% for stage IIb, but only 75 and 51% for stage IIc. The difference in actuarial survival between stage IIc patients and stage I, IIa and IIb patients was significant (p less than 0.01). These results indicate that radiation therapy is excellent treatment for stage I and II seminomas as long as the largest mass of disease is not greater than 5 cm (stage IIc). Patients with stage IIc seminoma are now treated with cisplatin-containing combination chemotherapy followed by radiation therapy to areas of bulk disease. Although the majority of patients with stage II disease in this series received mediastinal irradiation, this is no longer recommended at the JCRT.
1968年至1984年间，116例I期和II期原发性睾丸精原细胞瘤患者在联合放射治疗中心（JCRT）接受了治疗。114例患者（98%）获得了完整随访，中位随访时间为6年。整个组10年的精算无复发生存率（RFS）和生存率分别为94%和86%，27例患者在10年后仍有复发风险。按分期计算，I期10年的精算RFS和生存率分别为97%和92%，IIa期为93%和81%，IIb期为100%和100%，但IIc期仅为75%和51%。IIc期患者与I期、IIa期和IIb期患者的精算生存率差异有统计学意义（p<0.01）。这些结果表明，只要最大肿瘤直径不超过5 cm（IIc期），放射治疗是I期和II期精原细胞瘤的理想治疗方法。IIc期精原细胞瘤患者现在先接受含顺铂的联合化疗，然后对大块病灶区域进行放射治疗。尽管本系列中大多数II期疾病患者接受了纵隔照射，但JCRT现在不再推荐这种做法。
