Singhal S, Dixit S, Murthy R R, Neema J P, Vyas R K, Baboo H A
Department of Radiation Oncology, Gujarat Cancer & Research Institute, Ahlmedabad, India.
Indian J Cancer. 1994 Dec;31(4):226-34.
Twenty eight patients with stage II A and twenty patients with stage II B testicular seminoma were treated at this institute between January 1982 and December 1988. The three year crude survival observed in this retrospective analysis was 82% and 75% respectively. Post orchiectomy infradiaphragmatic radiotherapy was the mainstay of the treatment. In stage II A 4 patients were administered adjuvant chemotherapy as well. Prophylactic Mediastinal Irradiation (PMI) was not employed as a routine in this subgroup. Eight patients (28%) relapsed (Mediastinal Nodes--4, Pulmonary--3, Scrotal--1). In stage II B twelve patients were treated with primary abdominal radiotherapy and of them 4 were delivered PMI as well. Induction chemotherapy was administered in remaining 8 patients. Seven patients (35%) relapsed (Pulmonary-4, Mediastinal Nodes-3). Mediastinal recurrence was noted only in those who were treated with abdominal radiotherapy alone. Though salvage chemotherapy proved successful in 5 of the seven patients (70%) with nodal relapse, none of the patients with extranodal relapse responded to subsequent chemotherapy. For stage II A we recommend abdominal radiotherapy alone and for stage II B Induction chemotherapy is advised keeping radiotherapy reserved for residual mass. We do not advocate PMI as a routine in stage II testicular seminoma as no survival benefit is observed.
1982年1月至1988年12月期间，本研究所对28例II A期和20例II B期睾丸精原细胞瘤患者进行了治疗。在这项回顾性分析中观察到的三年总生存率分别为82%和75%。睾丸切除术后膈下放疗是主要的治疗方法。在II A期，也有4例患者接受了辅助化疗。该亚组未常规采用预防性纵隔照射（PMI）。8例患者（28%）复发（纵隔淋巴结转移4例、肺部转移3例、阴囊转移1例）。在II B期，12例患者接受了原发性腹部放疗，其中4例也接受了PMI。其余8例患者接受了诱导化疗。7例患者（35%）复发（肺部转移4例、纵隔淋巴结转移3例）。仅在那些仅接受腹部放疗的患者中观察到纵隔复发。尽管挽救性化疗在7例淋巴结复发患者中的5例（70%）中被证明是成功的，但没有一例结外复发患者对后续化疗有反应。对于II A期，我们建议仅进行腹部放疗，对于II B期，建议进行诱导化疗，将放疗保留用于残留肿块。我们不主张在II期睾丸精原细胞瘤中常规使用PMI，因为未观察到生存获益。
