Avuzzi Barbara, Tittarelli Andrea, Andreani Stefano, Noris Chiorda Barbara, Seregni Ettore, Villa Sergio, Tana Silvia, Valdagni Riccardo, Salvioni Roberto, Biasoni Davide, Catanzaro Mario, Stagni Silvia, Nicolai Nicola
Radiation Oncology 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Tumori. 2022 Apr;108(2):165-171. doi: 10.1177/0300891621992428. Epub 2021 Feb 15.
To evaluate local control and longitudinal endocrine data in monorchid patients treated with testicular-sparing surgery and adjuvant radiotherapy (RT) for seminomatous germ-cell tumors.
We searched our database established in 2009 for patients with seminoma who received testis irradiation following partial orchiectomy up to 2018. Eleven patients were identified. All had associated germ cell neoplasia in situ (GCNIS) in surrounding parenchyma. Analysis focused on local control and testosterone levels preservation after RT. We considered age, baseline (pre-RT) testosterone and luteinizing hormone (LH) levels, residual testicular volume, tumor size, and testosterone and LH levels trend over time in order to identify any association with endocrine impairment leading to hormonal replacement need.
After a median follow-up of 21 months, no local or distant relapses were observed and hormonal function was maintained in 54.5% of patients (6/11). No significant interactions were observed for the investigated covariates. Notably, we observed an association between higher baseline testosterone levels and a decreased risk of exogenous androgen replacement (hazard ratio [HR] 0.409, 95% confidence interval [CI] 0.161-1.039, = 0.060), whereas tumor size was associated with an increased risk of exogenous androgen replacement (HR 1.847, 95% CI 0.940-3.627, = 0.075).
Radiotherapy after testicular sparing surgery is effective in preventing local disease relapse in presence of GCNIS in the medium term. This strategy allows a preservation of adequate endocrine function in about half of patients. More patients and longer follow-up are needed to confirm these findings.
评估采用保留睾丸手术及辅助放疗（RT）治疗精原细胞瘤性生殖细胞肿瘤的单睾患者的局部控制情况及纵向内分泌数据。
我们在2009年建立的数据库中搜索2018年前接受部分睾丸切除术后睾丸照射的精原细胞瘤患者。共识别出11例患者。所有患者周围实质均伴有原位生殖细胞肿瘤（GCNIS）。分析重点为放疗后的局部控制情况及睾酮水平的保留情况。我们考虑了年龄、基线（放疗前）睾酮和促黄体生成素（LH）水平、残余睾丸体积、肿瘤大小以及睾酮和LH水平随时间的变化趋势，以确定与导致激素替代需求的内分泌损害的任何关联。
中位随访21个月后，未观察到局部或远处复发，54.5%的患者（6/11）激素功能得以维持。在所研究的协变量中未观察到显著的相互作用。值得注意的是，我们观察到较高的基线睾酮水平与外源性雄激素替代风险降低相关（风险比[HR]0.409，95%置信区间[CI]0.161 - 1.039，P = 0.060），而肿瘤大小与外源性雄激素替代风险增加相关（HR 1.847，95%CI 0.940 - 3.627，P = 0.075）。
保留睾丸手术后放疗在中期预防存在GCNIS的局部疾病复发方面是有效的。该策略可使约一半的患者维持足够的内分泌功能。需要更多患者及更长时间的随访来证实这些发现。
