Treatment results and long-term follow-up in stage I seminoma patients

Between 1979 and 1992 seventy-nine patients with seminoma were treated at our institution, 62 of them with stage I. The mean follow-up time was 6.0 years (range: 36 months to 14 years). Preoperatively, serum beta human chorionic gonadotropin (beta-HCG) was elevated in 12 cases (19%) without prognostic significance. In addition to orchiectomy, 57 patients with stage I seminoma of the testis received adjuvant radiotherapy (mean dose: 33 Gy). Two patients were treated with primary retroperitoneal lymph node dissection (RPLND) and one patient with cisplatin-based chemotherapy. In 2 cases a surveillance strategy was used. Three patients (5%) had a relapse of the seminoma (2 in the retroperitoneum and one suprainguinally). The time interval between orchiectomy and relapse was 5 to 60 months. Salvage treatment consisted of chemotherapy and RPLND in 2 patients and chemotherapy and resection of the suprainguinal recurrent mass in one patient, and was successful in all 3 patients. A total of 60 patients evaluated (100%) are still alive with no evidence of disease. In conclusion, adjuvant radiotherapy is considered the routine treatment in seminomas stage I despite studies with a 'wait and watch' policy or a carboplatin monotherapy.