Lester S G, Morphis J G, Hornback N B
Int J Radiat Oncol Biol Phys. 1986 Mar;12(3):353-8. doi: 10.1016/0360-3016(86)90350-0.
Pure testicular seminoma has historically been treated primarily with radiation therapy, and excellent results have been achieved. Recently, several aspects of the treatment of seminoma have been questioned; namely, the value of mediastinal irradiation in Stage II disease, and whether a dose response curve existed for seminoma. Because these questions have remained unanswered, we undertook a retrospective review of all patients with pure testicular seminoma treated in the Department of Radiation Oncology at Indiana University Medical Center. From 1961-1981, 54 patients with pure testicular seminoma were given megavoltage irradiation with curative intent. Thirty three patients were Stage I, with tumor confined to the testicle with no evidence of nodal spread. Fifteen patients were Stage IIA, with metastases less than 5 cm in size in the retroperitoneal nodes. Four patients were Stage IIB, with metastases greater than 5 cm in size in the retroperitoneal nodes. One patient was Stage III, with supradiaphragmatic metastases confined to the mediastinum and supraclavicular area. One patient was Stage IV, with evidence of extralymphatic metastases. The crude survival rate (corrected for intercurrent death, except for treatment toxicity) for the entire group was 87%. For Stage I, it was 91%, Stage IIA-80%, Stage IIB-75%, Stage III-100%, and Stage IV-0%. All patients had a minimum follow-up of 2 years with a range of 2 to 21 years. Evaluation of the Stage I patients reveals that 2500 rad in 3 weeks appears to be adequate in controlling microscopic disease, as there were no in-field recurrences when this dose was given. Those patients with Stage IIA and IIB disease who received greater than or equal to 3500 rad to macroscopic disease had 100% (7/7) survival and local control, while those receiving less than or equal to 3000 rad had a 66.6% (8/12) survival with three of four demonstrating persistent or recurrent abdominal disease. Thus, we feel that macroscopic disease requires 3500 rad to 4000 rad for control. All Stage II and III patients had planned mediastinal irradiation. No patients who received mediastinal irradiation recurred in the mediastinum. Whether this is because of our treatments or the natural disease process remains unanswered. Overall, we were able to salvage 12.5% (1/8) of our recurrences, while 37.5% (3/8) died from toxicity of their salvage therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
从历史上看，单纯睾丸精原细胞瘤主要采用放射治疗，且已取得了优异的效果。最近，精原细胞瘤治疗的几个方面受到了质疑；即II期疾病中纵隔照射的价值，以及精原细胞瘤是否存在剂量反应曲线。由于这些问题尚未得到解答，我们对印第安纳大学医学中心放射肿瘤学系治疗的所有单纯睾丸精原细胞瘤患者进行了回顾性研究。1961年至1981年期间，54例单纯睾丸精原细胞瘤患者接受了根治性兆伏放疗。33例为I期，肿瘤局限于睾丸，无淋巴结转移证据。15例为IIA期，腹膜后淋巴结转移灶小于5厘米。4例为IIB期，腹膜后淋巴结转移灶大于5厘米。1例为III期，膈上转移局限于纵隔和锁骨上区域。1例为IV期，有淋巴外转移证据。整个组的粗生存率（校正了并发死亡，治疗毒性除外）为87%。I期为91%，IIA期为80%，IIB期为75%，III期为100%，IV期为0%。所有患者的最短随访时间为2年，范围为2至21年。对I期患者的评估显示，3周内给予2500拉德似乎足以控制微小疾病，因为给予该剂量时没有野内复发。那些IIA期和IIB期疾病患者，对肉眼可见疾病接受大于或等于3500拉德照射的患者，生存率和局部控制率为100%（7/7），而接受小于或等于3000拉德照射的患者，生存率为66.6%（8/12），其中四分之三显示腹部疾病持续或复发。因此，我们认为肉眼可见疾病需要3500至4000拉德来控制。所有II期和III期患者都计划进行纵隔照射。接受纵隔照射的患者中，纵隔均未复发。这是因为我们的治疗还是自然病程，仍未得到解答。总体而言，我们能够挽救12.5%（1/8）的复发患者，而37.5%（3/8）死于挽救治疗的毒性。（摘要截断于400字）
