[Radiotherapy for the treatment of testicular seminomas]

Conventional treatment of testicular seminoma has been orchiectomy followed by adjuvant lymph node irradiation. Over the last 10 years the role of postoperative elective radiotherapy has been questioned. This paper reviews the role of radiotherapy in the treatment of seminoma of the testis.

The literature is reviewed with special reference to the results achieved in the treatment of testicular seminoma with and without radiotherapy. The advantages and disadvantages of postoperative radiotherapy, the techniques and dose administered are discussed.

The results obtained with radiotherapy postorchidectomy in stage I seminoma of the testis are excellent, with a disease free survival of 95%-100%. The use of more limited fields of irradiation and lower dose has reduced the radiation-induced toxicity. Currently, many centers have opted for clinical surveillance after orchiectomy. Their experience have permitted identification of the risk factors and there have been attempts to identify the group of patients that benefit from adjuvant therapy. The low incidence of stage II tumors has not permitted performing randomized studies to determine the benefits of adjuvant therapy and its comparison with chemotherapy. Consolidation radiotherapy for bulky stage II and stage III and IV tumors continues to be a controversy, although its potential value in carefully selected patients is recognized.