Long term toxicity and second malignancies in patients with testicular seminoma treated with radiotherapy

Abstract

Purpose/Objective: Stage 1 and 2a/b testicular seminoma treated with adjuvant radiotherapy has excellent cure rates. That fact combined with the relative young age of this patient population, has shifted the focus towards the evalution and prevention of the long term sequelae of radiotherapy. In this retrospective study, we report our experience with patients treated with post-orchidectomy radiotherapy.Materials/Methods: Between 1950 and 1995, 212 patients received adjuvant radiotherapy following orchidectomy for stage 1(169) and 2(43) seminoma at the London Regional Cancer Centre. The median folloW-up was 7.5 years. We reviewed patient records, focusing on late toxicity and second malignancies occuring after radiotherapy. All patients were treated with mega voltage machines (Cobalt 60,6mv,18mv).Results: 5/212 patients developed late g.i. complications post radio therapy. 4/212 patients developed second malignancies (actuarial; 1%, 1%, 4% at 5, 10, 15 years respectively). Progression free, cause specific and overall survival were 95%, 98% and 95% at 5 years and 94%, 98% and 94% at 10 years respectively. There was a trend towards increased acute complications for patients treated with larger volumes of radiation. No prognostic factors associated with increased risk of late toxicity or second malignancywere identified, likely a consequence of the small number of events.Conclusions: Overall the data suggest that the risk of late toxicity post treatment is minimal for patients with seminoma receiving adjuvant radiotherapy. Our rates of late G.I. toxicity and second malignancy were comparable to that reported in the literature. This reaffirms post-operative radiotherapy as a safe and effective adjuvant treatment for stage 1 and 2a/b seminoma. Purpose/Objective: Stage 1 and 2a/b testicular seminoma treated with adjuvant radiotherapy has excellent cure rates. That fact combined with the relative young age of this patient population, has shifted the focus towards the evalution and prevention of the long term sequelae of radiotherapy. In this retrospective study, we report our experience with patients treated with post-orchidectomy radiotherapy. Materials/Methods: Between 1950 and 1995, 212 patients received adjuvant radiotherapy following orchidectomy for stage 1(169) and 2(43) seminoma at the London Regional Cancer Centre. The median folloW-up was 7.5 years. We reviewed patient records, focusing on late toxicity and second malignancies occuring after radiotherapy. All patients were treated with mega voltage machines (Cobalt 60,6mv,18mv). Results: 5/212 patients developed late g.i. complications post radio therapy. 4/212 patients developed second malignancies (actuarial; 1%, 1%, 4% at 5, 10, 15 years respectively). Progression free, cause specific and overall survival were 95%, 98% and 95% at 5 years and 94%, 98% and 94% at 10 years respectively. There was a trend towards increased acute complications for patients treated with larger volumes of radiation. No prognostic factors associated with increased risk of late toxicity or second malignancywere identified, likely a consequence of the small number of events. Conclusions: Overall the data suggest that the risk of late toxicity post treatment is minimal for patients with seminoma receiving adjuvant radiotherapy. Our rates of late G.I. toxicity and second malignancy were comparable to that reported in the literature. This reaffirms post-operative radiotherapy as a safe and effective adjuvant treatment for stage 1 and 2a/b seminoma.