The Best Oncologist TM

 

Seminoma

By: Dr. Nicola J. Nasser, MD, PhD

September 24, 2012

·         Testicular cancer is the most common tumor among men between 15-35 yrs.

·         Risk factors: personal/family history of germ cell tumor, cryptorchidism, Klinefelter's syndrome.

 

·         testicular tumor types

·         AFP: T½ = 5-7 days; increases in yolk sac tumors/ embryonal carcinoma.

·         hCG: T½ = 1-3 days seminoma/ chroicarcinoma

·         Seminoma: no components of non seminoma & normal AFP.

·         Presentation: painless/ painful solid mass.

·         LDH / βHCG may be elevated in seminoma.

treatment of seminoma testis cancer  
 

The medical research council testicular tumor working group randomized patients with Stage I seminoma and undisturbed lymphatic drainage to receive paraaortic (PA) or dogleg (DL) fields. Three years relapse-free survival was 96% after PA radiotherapy and 96.6% after DL. Survival at 3 years was 99.3% for PA and 100% for DL radiotherapy. Nausea, vomiting, leukopenia was less frequent and less pronounced in patients in the PA arm.

seminoma radiation dog leg verus para-aortic

Subsequent trail from the MRC compared low radiation dose of 20 Gy to the para-aortic field versus 30 Gy and found that there was no difference in relpase free survival, but four weeks after starting radiotherapy, significantly more patients receiving 30 Gy reported moderate or severe lethargy (20% v 5%) and an inability to carry out their normal work (46% v 28%). However, by 12 weeks, levels in both groups were similar.

testicular cancer 20 Gy versus 30 Gy

 

Oliver et al. compared adjuvant treatment of patients with Stage I seminoma with radiotherapy (20-30 Gy) versus single agent carboplatin at a dose of AUC X 7. The results show noninferiority of single dose carboplatin versus RT in terms of RFR and establish a statistically significant reduction in the risk of second germ cell tumor produced by this treatment.

Carboplatin versus radiation in patients with testicular cancer and pure seminoma

Classen modification:

Classen et al described a modified dog leg field for treatment of seminoma:

Upper border: Between T10 – T11

Lower border: cranial rim of the ipsilateral acetabulum

Lateral borders - ipsilateral: include the transverse processes of the para-aortic vertebra to L5 – S1 then diagonally to the cranial lateral edge of acetabulum.

Lateral borders – contralateral: include the transverse processes of the para-aortic vertebra to L5 – S1 then diagonally in parallel with the ipsilateral border.

Radiation doses to stage IIA/ IIB seminoma

Stage IIA seminoma treatment doses: dog leg field with dose of 2 Gy x 10 fractions or 1.7 Gy x 15 fractions followed with boost to involved lymph nodes + 2 cm margin to 30 Gy.

Stage IIB seminoma treatment doses: dog leg field with dose of 2 Gy x 10 fractions or 1.7 Gy x 15 fractions followed with boost to involved lymph nodes + 2 cm margin to 36 Gy.

 

 

References:

  1. Optimal planning target volume for stage I testicular seminoma: A Medical Research Council randomized trial. Medical Research Council Testicular Tumor Working Group. Fossa SD. et al. J. Clin Oncol. 1999. To read this article press here.

  2. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I Testicular Seminoma: a report on Medical Research Council Trial TE18, European Organisation for the Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). Jones WG. et al. J. Clin Oncol. 2005. To read this article press here.

  3. Randomized trial of carboplatin versus radiotherapy for stage I seminoma: mature results on relapse and contralateral testis cancer rates in MRC TE19/EORTC 30982 study (ISRCTN27163214). Oliver RT. et al. J. Clin Oncol. 2011. To read this article press here.

  4. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. Classen et al. J. Clin. Oncol. 2003. To read this article press here.

 

 

 

 

 

 

 
 
 
 
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