Pelvic recurrence in stage I seminoma: A new phenomenon that questions modern protocols for radiotherapy and follow-up

• Published in: International journal of urology Vol. 12; no. 4; pp. 378 - 382
• Main Authors: POWER, RICHARD E, KENNEDY, JOHN, CROWN, JOHN, FRASER, IAN, THORNHILL, JOHN A
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Science Pty 01.04.2005
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bleomycin - administration & dosage; Bleomycin - therapeutic use; Cisplatin - administration & dosage; Cisplatin - therapeutic use; Etoposide - administration & dosage; Etoposide - therapeutic use; Follow-Up Studies; Humans; Male; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Orchiectomy; Pelvic Neoplasms - diagnostic imaging; Pelvic Neoplasms - drug therapy; Pelvic Neoplasms - secondary; pelvic relapse; radiation therapy; Radiotherapy, Adjuvant; Remission Induction - methods; Seminoma - radiotherapy; Seminoma - secondary; Seminoma - surgery; Stage 1 seminoma; Testicular Neoplasms - pathology; Testicular Neoplasms - radiotherapy; Testicular Neoplasms - surgery; Tomography, X-Ray Computed
• ISSN: 0919-8172; 1442-2042
• DOI: 10.1111/j.1442-2042.2005.01114.x

Objective:  To highlight the increased risk for pelvic relapse in patients with stage 1 seminoma treated with adjuvant radiotherapy limited to para‐aortic template alone. Patients and methods:  Over a four‐year period, three patients presented with early pelvic recurrence after radical orchidectomy and adjuvant irradiation for stage 1 seminoma. In each case, radiotherapy had been limited to the para‐aortic region with omission of the ipsilateral hemi pelvis. Results:  Pelvic recurrences occurred on the ipsilateral tumor side. Durable complete remission was achieved in each case; however, treatment was complex and there was associated morbidity. Conclusion:  This significant incidence of pelvic recurrence questions the validity of modern radiotherapy protocol which excludes the ipsilateral pelvis from the radiation field.