Warszawski N, Schmücking M
Department of Radiotherapy, University Hospital of Magdeburg, Germany.
Scand J Urol Nephrol. 1997 Aug;31(4):355-9. doi: 10.3109/00365599709030619.
Being among the most radiosensitive tumours, radiation therapy has replaced retroperitoneal lymphadenectomy in the treatment of early-stage testicular seminoma. One hundred and sixty-one patients who were treated from 1975 through to 1991 with histologically confirmed testicular seminoma of stages I and II were analyses retrospectively. After high semicastration, 98 patients were treated by radiation therapy of regional lymph nodes and 63 patients received retroperitoneal lymphadenectomy. Until 1985 retroperitoneal lymphadenectomy was preferred, but after 1985 radiotherapy outweighed retroperitoneal lymphadenectomy. The follow-up ranged from 11 months to 13.5 years, with a median of 79 months. Retroperitoneally, in-field relapses occurred in 9.5% (6/63 patients) after retroperitoneal lymphadenectomy and in 2.0% (2/98 patients) after radiation therapy (Fisher exact test, p = 0.057). A trend to a higher frequency of retroperitoneal relapses after retroperitoneal lymphadenectomy seemed to be apparent. Relapses outside the operation site or radiation fields were registered with non-significantly different frequencies (p = 0.741) of 4.8% (3/63 patients) and 7.1% (7/98 patients), respectively. Relapses increased from 4.1% for stage I (5/121 patients) up to 58.3% for stage IIC (7/12 patients).
作为对放疗最敏感的肿瘤之一，放射治疗已取代腹膜后淋巴结清扫术用于早期睾丸精原细胞瘤的治疗。对1975年至1991年期间接受治疗的161例经组织学确诊为Ⅰ期和Ⅱ期睾丸精原细胞瘤的患者进行了回顾性分析。高位睾丸切除术后，98例患者接受了区域淋巴结放射治疗，63例患者接受了腹膜后淋巴结清扫术。直到1985年，腹膜后淋巴结清扫术更受青睐，但1985年后放射治疗超过了腹膜后淋巴结清扫术。随访时间为11个月至13.5年，中位时间为79个月。在腹膜后，腹膜后淋巴结清扫术后9.5%（6/63例患者）出现野内复发，放射治疗后2.0%（2/98例患者）出现野内复发（Fisher精确检验，p = 0.057）。腹膜后淋巴结清扫术后腹膜后复发频率较高的趋势似乎很明显。手术部位或放射野外的复发率分别为4.8%（3/63例患者）和7.1%（7/98例患者），差异无统计学意义（p = 0.741）。复发率从Ⅰ期的4.1%（5/121例患者）增加到ⅡC期的58.3%（7/12例患者）。
