Testicular seminoma: effectiveness of primary radiation therapy

We retrospectively studied 44 patients with testicular seminoma treated with primary radiation therapy at the Bowman Gray School of Medicine from 1972 through 1982. The 26 patients with stage I disease received infradiaphragmatic irradiation. Eleven of the 12 with stage II disease, the three with stage III disease, and three with retroperitoneal disease received irradiation to the mediastinum and infradiaphragmatic area. The three-year survival rate without evidence of disease was 100% for stage I. For stage II, the rate was 92% with radiation therapy alone and 100% with salvage therapy. In two patients with stage III disease radiation therapy failed, but both had bulky abdominal disease. Only one died of seminoma. One of the patients with retroperitoneal tumor had unsuccessful radiation therapy but was salvaged with chemotherapy. Neither the diagnosis of anaplastic seminoma in nine patients nor elevated preorchiectomy beta-HCG levels in four patients affected their prognosis. In our series, primary radiation therapy with proper salvage therapy yielded 98% survival.