Harvard Radiation Oncology Program, Boston, MA, USA.
Internal Medicine Residency Program, University of Hawaii, Honolulu, HI, USA.
World J Urol. 2023 Dec;41(12):3895-3903. doi: 10.1007/s00345-023-04674-8. Epub 2023 Nov 18.
Novel techniques and advances in radiation therapy (RT) have been explored to treat testicular seminoma, a highly radiosensitive and curable histology. We evaluated the historical and current indications for radiation therapy (RT) in testicular seminoma.
A narrative literature review was performed. Studies of RT for testicular seminoma were included. Additionally, recent trials testing the use of combination or surgical therapies for clinical stage (CS) II were included. Search parameters included radiation therapy, testicular seminoma, surgery, and chemoradiation. Parameters and outcomes assessed were progression-free survival (PFS), overall survival (OS), acute toxicities, long-term sequelae, and rates of secondary malignancies.
Practice defining and changing studies in the use or omission of radiation therapy for testicular seminoma were identified along with resultant changes in National Comprehensive Cancer Network (NCCN) and European guidelines. Recent trials in combined chemoradiation and upfront surgical approaches to CS II disease were reviewed.
RT has historically been used as adjuvant treatment for CS I disease and is highly effective at treating CS II (A/B) testicular seminoma. The drive to maintain therapeutic efficacy and reduce acute and long-term side effects, namely secondary malignancies, is being tested using new radiation technologies, combined modality therapy in the form of chemoradiation and with upfront surgical approaches. Also, as guidelines now "strongly prefer" surveillance instead of adjuvant RT for CS I disease, the current CS II population comprises patients presenting with CS II disease ("de novo") and those who present with CSII after relapsing post orchiectomy for CS I ("relapsed"). Emerging evidence suggests that these two groups have different outcomes with respect to RT and chemoradiation. Consequently, future trials may need to sub-stratify according to these groups.
探索放射治疗（RT）的新技术和进展，以治疗高度敏感和可治愈的组织学睾丸精原细胞瘤。我们评估了放射治疗（RT）在睾丸精原细胞瘤中的历史和当前适应证。
进行了叙述性文献复习。纳入了睾丸精原细胞瘤的 RT 研究。此外，还纳入了最近测试联合或手术治疗临床分期（CS）II 期的试验。搜索参数包括放射治疗、睾丸精原细胞瘤、手术和放化疗。评估的参数和结果包括无进展生存期（PFS）、总生存期（OS）、急性毒性、长期后遗症和继发性恶性肿瘤的发生率。
确定了定义和改变睾丸精原细胞瘤中使用或省略放射治疗的研究实践，以及国家综合癌症网络（NCCN）和欧洲指南的相应变化。回顾了 CS II 疾病联合放化疗和 upfront 手术方法的最新试验。
RT 历史上一直被用作 CS I 疾病的辅助治疗，对 CS II（A/B）睾丸精原细胞瘤的治疗非常有效。为了保持治疗效果并降低急性和长期副作用，特别是继发性恶性肿瘤的风险，正在使用新的放射技术、放化疗联合以及 upfront 手术方法进行测试。此外，由于指南现在“强烈推荐”对 CS I 疾病进行监测而不是辅助 RT，目前的 CS II 人群包括出现 CS II 疾病的患者（“新发”）和出现 CS I 手术后复发的 CS II 患者（“复发”）。新出现的证据表明，这两组患者在 RT 和放化疗方面的结果不同。因此，未来的试验可能需要根据这些组进行亚分层。
