Radiation therapy and chemotherapy in the management of testicular seminoma: a review.

Since the early '50s, radiation therapy has been regarded as the mainstay of treatment for testicular seminoma. In the last decade, however, several reports claimed optimal control (about 80% of lasting complete remissions) of advanced disease with cisplatin-containing chemotherapy regimens, consequently questioning the opportunity of irradiation in bulky retroperitoneal presentation. The respective role of radiotherapy and chemotherapy in the management of advanced locoregional seminoma has been reviewed, in view of the fact that our data, previously unpublished, show a 10-year disease-free survival probability of 70% for 27 bulky stage II patients submitted to irradiation. On the grounds of currently available data, a prospective randomized trial of chemotherapy versus radiotherapy in stage II testicular seminoma seems justified, in order to identify the optimal treatment policy for this disease.