Controversies in management of stages I and II testicular seminomas

The general success in treating seminoma (Stages I and II) of the testicle has prompted questions regarding the extent of treatment that these patients require. We reviewed 79 patients treated at NYU/Bellevue Medical Center from 1965 to 1984 to establish a data base from which the controversies surrounding this disease can be viewed. Standard treatment involved a radical inguinal orchiectomy as primary therapy. Stage I patients received adjuvant radiation to para-aortic and ipsilateral iliac nodes, with additional radiation given routinely to the mediastinum of patients with Stage II disease. No major complications were observed. All Stage I patients remain free of recurrent tumor with a median follow-up of eight years. There were 4 deaths from seminoma among the Stage II patients. The use of prophylactic mediastinal radiation for Stage II patients, and observation only for Stage I patients are reviewed in light of our results and other published series. While early evidence suggests that both approaches may be reasonable, their adoption awaits confirmation by prospective trial.