Limitations to the use of surveillance as an option in the management of stage I seminoma.

Improved definition of seminoma using step sections and tumour markers makes such patients a more selected group than when radiotherapy was first introduced. This and the improvements in radiological staging and the exquisite sensitivity of metastatic seminoma to chemotherapy justifies reappraisal of the role of prophylactic radiotherapy. To investigate this, twenty-six patients have been entered onto a programme of prospective biochemical and radiological surveillance. Though only four (15%) have relapsed, and all easily salvaged by chemotherapy, the relative difficulty and lateness of establishing the diagnosis makes this approach unsuitable for service use. Whether given the chemosensitivity of seminomas, radiotherapy would remain the treatment of choice compared to short courses of adjuvant carboplatin requires testing in a randomized trial.