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Testicular seminoma: 20-year experience at the Northern Israel Oncology Center (1968–1988)

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Abstract

Eighty-four patients with testicular seminoma were treated at the Northern Israel Oncology Center during the years 1968–1988. Using the staging classification of Hussey, 69 patients (82%) had Stage I, eight (10%) had Stage IIA, four (5%) had Stage IIB, one (1%) had Stage IIIA, and two (2%) had Stage IIIB disease. Sixtynine patients (82%) had classic pure seminoma, nine (11%) had anaplastic seminoma and six (7%) had spermatocytic seminoma. Seventy-four patients (88%) underwent high inguinal orchiectomy and ten (12%) had a scrotal approach. Seventy-five patients (85%) were treated with postoperative irradiation. Stage I patients received 26–30 Gy to the paraaortic and ipsilateral pelvic lymph nodes. Stage IIA patients were treated in the same manner with a boost to the involved lymph nodes. With a mean follow-up of 97 months, 65 patients (77%) are alive and well with no evidence of disease, 7 patients (8%) are dead due to disease progression. The 5-, 10-, 15-, and 20-year actuarial survival for all patients was 90%, and for early stage patients 94%. Eight patients (14%) relapsed; 3 of them were salvaged by chemotherapy.

Serious side effects of irradiation included lethal respiratory failure due to bleomycin-induced pulmonary fibrosis in one patient, peptic ulcer in three patients, hydronephrosis due to paraureteral fibrosis in one patient and recurrent paralytic ileus in one patient. Eight patients (10%) developed nine second cancers, three of them within the previous radiation field.

It is concluded that appropriate planning and adequate radiation dose can yield a 20-year disease-free survival rate for more than 90% of patients with early stage testicular seminoma. Accurate staging may prevent overtreatment, thus reducting long-term toxicity. Because of the risk of developing a second primary cancer, careful follow-up monitoring with a high index of suspicion for such disorders is warranted.

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Authors and Affiliations

  1. Northern Israel Oncology Center, Rambam Medical Center, and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    M. Stein & M. Steiner

  2. Department of Urology, Bnei Zion Medical Center, Haifa, Israel

    B. Moshkowitz

  3. Oncology Unit, Ha’emek Central Hospital, Afula, Israel

    D. Sapir

  4. Department of Radiotherapy, Rand Clinic, Johannesburg, Republic of South Africa

    I. Kessel

  5. Radiation Therapy Unit, Northern Israel Oncology Center, Haifa, Israel

    A. Kuten

Authors
  1. M. Stein
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  2. M. Steiner
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  3. B. Moshkowitz
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  4. D. Sapir
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  5. I. Kessel
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  6. A. Kuten
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Stein, M., Steiner, M., Moshkowitz, B. et al. Testicular seminoma: 20-year experience at the Northern Israel Oncology Center (1968–1988). International Urology and Nephrology 26, 461–469 (1994). https://doi.org/10.1007/BF02768019

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