Evaluating changes in stage I seminoma management: a single institution review

Historically adjuvant radiotherapy has been routinely recommended for stage I seminoma patients but surveillance has become an increasingly popular option over the last decade. We therefore decided to review the approach currently used by the radiation oncologists at our center.

A 14-item questionnaire evaluating physician opinions about treatment options for stage I seminoma patients was developed at the Ottawa Hospital Regional Cancer Centre (OHRCC). It was sent to all the radiation oncologists at OHRCC treating genitor-urinary (GU) malignancies for self-completion.

All the GU radiation oncologists completed the survey for a response rate of 100% (7/7). Most (71%) have been treating GU malignancies for at least 5 years with the median being 9 years. At present, all consider surveillance and adjuvant radiotherapy as standard treatment options for stage I seminoma patients, and recommend these to patients. They give patients information about the treatment options but also give their personal recommendations as well. Most have been routinely discussing surveillance as an option since the late 1990's. Clinical data from the OHRCC confirms that there has been a significant increase in the proportion of stage I seminoma patients being managed by surveillance over the past 15 years. Currently almost half of patients are choosing surveillance.

There appears to be a fairly uniform approach towards the management of stage I seminoma patients at the OHRCC. Radiation oncologists are now routinely offering both surveillance and adjuvant radiotherapy as reasonable option for these patients, and this is consistent with the recently published literature on this topic.