Schmidberger H, Bamberg M, Meisner C, Classen J, Winkler C, Hartmann M, Templin R, Wiegel T, Dornoff W, Ross D, Thiel H J, Martini C, Haase W
Department of Radiotherapy, Tübingen, Germany.
Int J Radiat Oncol Biol Phys. 1997 Sep 1;39(2):321-6. doi: 10.1016/s0360-3016(97)00155-7.
A prospective multicenter study was carried out to estimate the treatment outcome of radiotherapy in Stage II seminoma after the application of modern staging and radiotherapy techniques. The lower margin of the iliac field was positioned on the upper rim of the acetabulum to reduce the amount of scattered irradiation to the remaining testicle.
The study was carried out in 25 centers in Germany. Patients with pure seminoma, negative AFP-values, and retroperitoneal lymph node metastases of less than 5 cm in diameter were entered into the study. All patients received a ventrodorsal opposed field irradiation of the para-aortic and the ipsilateral iliac lymph nodes. The fields extended from the top of the 11th thoracic vertebra to the top of the acetabulum. Patients in Stage IIA (lymph nodes <2 cm ) received 30 Gy, and patients with Stage IIB (lymph nodes between 2 and 5 cm) 36 Gy total dose.
39 patients in Stage IIA and 19 patients in Stage IIB were evaluated. After a median observation time of 37 months all patients are alive and disease free. Recurrence free survival in stage IIA was 100%. Two patients in Stage IIB experienced a recurrence 10 and 17 months after the end of radiotherapy. The actuarial recurrence free survival estimate in Stage IIB was 94.1% for 1 year and 87.4% for 2 years. One recurrence in Stage IIB occurred in the mediastinum, one in the mediastinum, and one the lung. Both patients could be salvaged by chemotherapy. There were no pelvic recurrences. The treatment was well tolerated, with nausea being the most common side effect (56.9% Grade 1, 15.5% Grade 2, and 8.6% Grade 3). Diarrhea occurred in 15.5% (Grade 1), 15.5% (Grade 2), and 5.2% (Grade 3) of the patients.
The outcome of para-aortic and ipsilateral iliac irradiation in Stage IIA/B testicular seminoma is excellent with the currently available staging methods and treatment facilities. The treatment is well tolerated. The lower margin of the iliacal field can be placed at the acetabulum.
开展一项前瞻性多中心研究，以评估在应用现代分期和放疗技术后，II期精原细胞瘤的放疗治疗效果。髂骨野的下缘置于髋臼上缘，以减少对剩余睾丸的散射照射量。
该研究在德国的25个中心进行。纳入研究的患者为纯精原细胞瘤、甲胎蛋白值阴性且直径小于5 cm的腹膜后淋巴结转移患者。所有患者均接受腹背相对野照射主动脉旁和同侧髂淋巴结。照射野从第11胸椎顶部延伸至髋臼顶部。IIA期（淋巴结<2 cm）患者接受30 Gy照射，IIB期（淋巴结在2至5 cm之间）患者总剂量为36 Gy。
评估了39例IIA期患者和19例IIB期患者。中位观察时间为37个月后，所有患者均存活且无疾病。IIA期的无复发生存率为100%。IIB期有2例患者在放疗结束后10个月和17个月出现复发。IIB期的精算无复发生存率估计1年为94.1%，2年为87.4%。IIB期有1例复发发生在纵隔，1例在纵隔，1例在肺部。两名患者均通过化疗挽救。无盆腔复发。治疗耐受性良好，恶心是最常见的副作用（1级56.9%，2级15.5%，3级8.6%）。腹泻发生在15.5%（1级）、15.5%（2级）和5.2%（3级）的患者中。
采用目前可用的分期方法和治疗设备，IIA/B期睾丸精原细胞瘤的主动脉旁和同侧髂骨照射效果极佳。该治疗耐受性良好。髂骨野的下缘可置于髋臼处。
