Anaplastic seminoma and spermatocytic seminoma--a retrospective analysis

Through the years 1968-1990, 10 patients with anaplastic seminoma and 7 patients with spermatocytic seminoma were referred to the Northern Israel Oncology Center, Haifa, Israel. These patients represent 20% of a total of 85 seminoma patients referred for treatment and follow-up. All patients underwent orchiectomy. Metastatic work-up revealed stage I disease in all patients. Sixteen patients received postoperative prophylactic radiation therapy to the para-aortic lymph nodes and the ipsilateral iliac region, dose range 25-30 Gy (daily fractionation 200 cGy). With a mean follow-up of 98 months, 15 patients are alive with no evidence of disease or long-term side-effects of treatment. One patient died of ischaemic heart disease without evidence of recurrent tumour. One patient with anaplastic seminoma died from progressive disease. In the light of our experience and a review of the literature, it is suggested that treatment of stage I non-pure seminoma should be based on the extent of disease alone and not on the degree of histological differentiation. Stage I non-pure seminoma has the same good long-term survival and low complication rate as typical seminoma when treated with adjuvant radiotherapy. Prospective, randomised trials are required to evaluate the role of a surveillance policy alone in stage I non-pure seminoma.