Long-term Results of Adjuvant Irradiation or Surveillance in Stage I Testicular Seminoma

Background: Excellent treatment results are obtained for stage I testicular seminoma treated with orchiectomy and prophylactic radiotherapy. In patients with stage I nonseminomatous testicular tumors, surveillance alone is successful, however, this treatment option for stage I testicular seminomas is controversial. There have been few reports of long‐term follow‐up of surveillance alone for patients with stage I testicular seminoma. Methods: To assess the appropriateness of this treatment option, a retrospective survey of stage I testicular seminoma was undertaken. Twenty‐seven patients who underwent prophylactic radiation therapy (RT group) and 41 patients followed only by surveillance (S group) after high orchiectomy were evaluated. Their follow‐up consisted of frequent clinical examinations, abdominal CT scans, chest x‐rays and serum tumor markers. Results: In the RT group, with a median follow‐up period of 15 years, 1 patient (3.6%) had a recurrence in the lung at 4 months after orchiectomy and died, but the remaining 26 are alive with no evidence of disease (NED). In the S group, with a median follow‐up period of 7.3 years, 5 (12.2%) relapsed in the retroperitoneal lymph nodes, but all are alive with NED following chemotherapy. The remaining 36 are all alive without recurrence (follow‐up period, 38 to 132 months). Although the relapse rate in the S group was relatively higher than in the RT group, there was no significant difference between the 2 groups. Conclusion: If a frequent follow‐up protocol is administered and followed by the patient, surveillance alone may be a recommended management for stage I testicular seminoma.