[Radiotherapy of testicular seminoma: changes over the past 10 years]

Radiotherapy is generally considered as the standard treatment for most testicular seminomas. However, there have been substantial changes in the management of these tumours over the past few years. In early seminoma, there is a trend towards a decrease in treatment intensity or even towards therapeutic abstention (i.e. surveillance); whereas in advanced cases, combination chemotherapy is taking over from radiotherapy. In stage I, where cure rates are almost 100%, the limiting of the lymph node area to be irradiated and decrease of the dose to 20-25 Gy was followed by very low long-term toxicity rates, and a very small risk of infertility, without compromising the overall prognosis. Surveillance is an acceptable alternative to postoperative radiotherapy. However, the risk of nodal relapse is around 18-20%. With surveillance, the frequency and duration of follow-up is increased in comparison to the same with postoperative radiotherapy, with higher cost. In stage IIa, radiotherapy remains the standard but recent studies have shown that limiting the nodal volume to the paraortic area is justified as in stage I. In stage IIb and higher, combination chemotherapy is almost always given. However, the association between carboplatin and radiotherapy represents an efficient and well-tolerated alternative. Late tissue damage and the risk of decrease in fertility are minimized with novel radiotherapeutic approaches. However, the occurrence of second cancers in the long term is a matter of concern. It is possible though, that patients with seminoma have a tendency per se to develop second cancers. The prognosis of cryptorchid seminoma and of HCG-producing seminoma has been the subject of controversy but recent large studies have demonstrated that stage for stage, the cure rates are similar to those of other seminomas.