Genitourinary Cancers

  • Nicholas G. ZaorskyEmail author
  • Daniel M. Trifiletti
  • Katherine Tzou


This chapter discusses the general management of patients with genitourinary tract cancers, with special focus on principles that guide radiotherapy management. Several key components of trimodality care and brachytherapy are discussed.


Prostate Testicular Bladder Renal 


  1. 1.
    Schroder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. N Engl J Med. 2012;366:981–90.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate cancer mortality: results of the European randomised study of screening for prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. 2014;384:2027–35.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Baumann BC, Guzzo TJ, He J, et al. Bladder cancer patterns of pelvic failure: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys. 2013;85:363–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Pound CR, Partin AW, Eisenberger MA, et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA. 1999;281:1591–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Kucway R, Vicini F, Huang R, et al. Prostate volume reduction with androgen deprivation therapy before interstitial brachytherapy. J Urol. 2002;167:2443–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Thompson IM, Valicenti RK, Albertsen P, et al. Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO guideline. J Urol. 2013;190:441–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Yamada Y, Rogers L, Demanes DJ, et al. American brachytherapy society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy. 2012;11:20–32.PubMedCrossRefGoogle Scholar
  8. 8.
    Martinez-Monge R, Gomez-Iturriaga A, Cambeiro M, et al. Phase I-II trial of perioperative high-dose-rate brachytherapy in oral cavity and oropharyngeal cancer. Brachytherapy. 2009;8:26–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Cook B DT: Wikibooks radiation oncology.Google Scholar
  10. 10.
    Edge S, Byrd D, Compton C, et al. AJCC cancer staging manual. New York: Springer; 2010.Google Scholar
  11. 11.
    Hansen ERM. Handbook of evidence-based radiation oncology second edition: Springer; 2010.Google Scholar
  12. 12.
    Hristov BLS, Christodouleas JP. Radiation oncology – a question based review. 2nd ed: LWW; 2014.Google Scholar
  13. 13.
    Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med. 2005;352:1977–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Dearnaley DP, Sydes MR, Graham JD, et al. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2007;8:475–87.PubMedCrossRefGoogle Scholar
  15. 15.
    Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:67–74.PubMedCrossRefGoogle Scholar
  16. 16.
    Kupelian PA, Elshaikh M, Reddy CA, et al. Comparison of the efficacy of local therapies for localized prostate cancer in the prostate-specific antigen era: a large single-institution experience with radical prostatectomy and external-beam radiotherapy. J Clin Oncol. 2002;20:3376–85.PubMedCrossRefGoogle Scholar
  17. 17.
    Peeters ST, Heemsbergen WD, Koper PC, et al. Dose-response in radiotherapy for localized prostate cancer: results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24:1990–6.PubMedCrossRefGoogle Scholar
  18. 18.
    Pommier P, Chabaud S, Lagrange JL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol. 2007;25:5366–73.PubMedCrossRefGoogle Scholar
  19. 19.
    Zietman AL, Bae K, Slater JD, et al. Randomized trial comparing conventional-dose with high-dose conformal radiation therapy in early-stage adenocarcinoma of the prostate: long-term results from proton radiation oncology group/american college of radiology 95-09. J Clin Oncol. 2010;28:1106–11.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Avkshtol V, Dong Y, Hayes SB, et al. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer. Res Rep Urol. 2016;8:145–58.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Johnson ME, Zaorsky NG, Martin JM, et al. Patient reported outcomes among treatment modalities for prostate cancer. Can J Urol. 2016;23:8535–45.PubMedGoogle Scholar
  22. 22.
    Zaorsky NG, Egleston BL, Horwitz EM, et al. The missing pieces in reporting of randomized controlled trials of external beam radiation therapy dose escalation for prostate Cancer. Am J Clin Oncol. 2016;39:321–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Zaorsky NG, Harrison AS, Trabulsi EJ, et al. Evolution of advanced technologies in prostate cancer radiotherapy. Nat Rev Urol. 2013;10:565–79.PubMedCrossRefGoogle Scholar
  24. 24.
    Zaorsky NG, Keith SW, Shaikh T, et al. Impact of radiation therapy dose escalation on prostate Cancer outcomes and toxicities. Am J Clin Oncol. 2018;41(4):409–15.Google Scholar
  25. 25.
    Zaorsky NG, Ohri N, Showalter TN, et al. Systematic review of hypofractionated radiation therapy for prostate cancer. Cancer Treat Rev. 2013;39:728–36.PubMedCrossRefGoogle Scholar
  26. 26.
    Zaorsky NG, Palmer JD, Hurwitz MD, et al. What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation. Radiother Oncol. 2015;115:295–300.PubMedCrossRefGoogle Scholar
  27. 27.
    Zaorsky NG, Shaikh T, Murphy CT, et al. Comparison of outcomes and toxicities among radiation therapy treatment options for prostate cancer. Cancer Treat Rev. 2016;48:50–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Nobes JP, Langley SE, Klopper T, et al. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. BJU Int. 2012;109:1495–502.CrossRefGoogle Scholar
  29. 29.
    Hamdy FC, Donovan JL, Lane JA, et al. 10-year outcomes after monitoring, surgery, or radiotherapy for localized prostate Cancer. N Engl J Med. 2016;375:1415–24.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Dearnaley D, Syndikus I, Mossop H, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016;17:1047–60.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Kestin L, Goldstein N, Vicini F, et al. Treatment of prostate cancer with radiotherapy: should the entire seminal vesicles be included in the clinical target volume? Int J Radiat Oncol Biol Phys. 2002;54:686–97.PubMedCrossRefGoogle Scholar
  32. 32.
    Asbell SO, Krall JM, Pilepich MV, et al. Elective pelvic irradiation in stage A2, B carcinoma of the prostate: analysis of RTOG 77-06. Int J Radiat Oncol Biol Phys. 1988;15:1307–16.PubMedCrossRefGoogle Scholar
  33. 33.
    Bolla M, Collette L, Blank L, et al. Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet. 2002;360:103–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Bolla M, de Reijke TM, Van Tienhoven G, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360:2516–27.PubMedCrossRefGoogle Scholar
  35. 35.
    Crook J, Patil N, Wallace K, et al. A phase III randomized trial of the timing of meloxicam with iodine-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2010;77:496–501.PubMedCrossRefGoogle Scholar
  36. 36.
    Denham JW, Steigler A, Lamb DS, et al. Short-term androgen deprivation and radiotherapy for locally advanced prostate cancer: results from the trans-Tasman radiation oncology group 96.01 randomised controlled trial. Lancet Oncol. 2005;6:841–50.PubMedCrossRefGoogle Scholar
  37. 37.
    Horwitz EM, Bae K, Hanks GE, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol. 2008;26:2497–504.PubMedCrossRefGoogle Scholar
  38. 38.
    Jones CU, Hunt D, McGowan DG, et al. Radiotherapy and short-term androgen deprivation for localized prostate cancer. N Engl J Med. 2011;365:107–18.PubMedCrossRefGoogle Scholar
  39. 39.
    Lawton CA, DeSilvio M, Roach M 3rd, et al. An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys. 2007;69:646–55.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Pilepich MV, Winter K, Lawton CA, et al. Androgen suppression adjuvant to definitive radiotherapy in prostate carcinoma--long-term results of phase III RTOG 85-31. Int J Radiat Oncol Biol Phys. 2005;61:1285–90.PubMedCrossRefGoogle Scholar
  41. 41.
    Roach M 3rd, Bae K, Speight J, et al. Short-term neoadjuvant androgen deprivation therapy and external-beam radiotherapy for locally advanced prostate cancer: long-term results of RTOG 8610. J Clin Oncol. 2008;26:585–91.PubMedCrossRefGoogle Scholar
  42. 42.
    Steigler A, Denham JW, Lamb DS, et al. Risk stratification after biochemical failure following curative treatment of locally advanced prostate Cancer: data from the TROG 96.01 trial. Prostate Cancer. 2012;814724:2012.Google Scholar
  43. 43.
    Stephenson AJ, Kattan MW, Eastham JA, et al. Prostate cancer-specific mortality after radical prostatectomy for patients treated in the prostate-specific antigen era. J Clin Oncol. 2009;27:4300–5.PubMedPubMedCentralCrossRefGoogle Scholar
  44. 44.
    Widmark A, Klepp O, Solberg A, et al. Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial. Lancet. 2009;373:301–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Morris WJ, Tyldesley S, Rodda S, et al. Androgen suppression combined with elective nodal and dose escalated radiation therapy (the ASCENDE-RT trial): an analysis of survival endpoints for a randomized trial comparing a low-dose-rate brachytherapy boost to a dose-escalated external beam boost for high- and intermediate-risk prostate Cancer. Int J Radiat Oncol Biol Phys. 2017;98:275–85.PubMedCrossRefGoogle Scholar
  46. 46.
    Hanks GE, Pajak TF, Porter A, et al. Phase III trial of long-term adjuvant androgen deprivation after neoadjuvant hormonal cytoreduction and radiotherapy in locally advanced carcinoma of the prostate: the radiation therapy oncology group protocol 92-02. J Clin Oncol. 2003;21:3972–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Pisansky TM, Hunt D, Gomella LG, et al. Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910. J Clin Oncol. 2015;33:332–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Zapatero A, Guerrero A, Maldonado X, et al. High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial. Lancet Oncol. 2015;16:320–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Spiotto MT, Hancock SL, King CR. Radiotherapy after prostatectomy: improved biochemical relapse-free survival with whole pelvic compared with prostate bed only for high-risk patients. Int J Radiat Oncol Biol Phys. 2007;69:54–61.PubMedCrossRefGoogle Scholar
  50. 50.
    Hanks GE, Buzydlowski J, Sause WT, et al. Ten-year outcomes for pathologic node-positive patients treated in RTOG 75-06. Int J Radiat Oncol Biol Phys. 1998;40:765–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Bolla M, van Poppel H, Collette L, et al. Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911). Lancet. 2005;366:572–8.PubMedCrossRefGoogle Scholar
  52. 52.
    King CR, Presti JC Jr, Gill H, et al. Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes? Int J Radiat Oncol Biol Phys. 2004;59:341–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Messing EM, Manola J, Yao J, et al. Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006;7:472–9.PubMedCrossRefGoogle Scholar
  54. 54.
    Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term follow-up of a randomized clinical trial. J Urol. 2009;181:956–62.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Wiegel T, Bottke D, Steiner U, et al. Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol. 2009;27:2924–30.PubMedCrossRefGoogle Scholar
  56. 56.
    Zagars GK, Pollack A, von Eschenbach AC. Addition of radiation therapy to androgen ablation improves outcome for subclinically node-positive prostate cancer. Urology. 2001;58:233–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Swanson GP, Hussey MA, Tangen CM, et al. Predominant treatment failure in postprostatectomy patients is local: analysis of patterns of treatment failure in SWOG 8794. J Clin Oncol. 2007;25:2225–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Sella T, Schwartz LH, Swindle PW, et al. Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology. 2004;231:379–85.PubMedCrossRefGoogle Scholar
  59. 59.
    Carrie C, Hasbini A, de Laroche G, et al. Salvage radiotherapy with or without short-term hormone therapy for rising prostate-specific antigen concentration after radical prostatectomy (GETUG-AFU 16): a randomised, multicentre, open-label phase 3 trial. Lancet Oncol. 2016;17:747–56.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
    Abdollah F, Karnes RJ, Suardi N, et al. Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer. J Clin Oncol. 2014;32:3939–47.PubMedCrossRefGoogle Scholar
  61. 61.
    Stephenson AJ, Shariat SF, Zelefsky MJ, et al. Salvage radiotherapy for recurrent prostate cancer after radical prostatectomy. JAMA. 2004;291:1325–32.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Michalski JM, Lawton C, El Naqa I, et al. Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76:361–8.PubMedCrossRefGoogle Scholar
  63. 63.
    Advanced Bladder Cancer Meta-analysis Collaboration. Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet. 2003;361:1927–34.Google Scholar
  64. 64.
    Cole CJ, Pollack A, Zagars GK, et al. Local control of muscle-invasive bladder cancer: preoperative radiotherapy and cystectomy versus cystectomy alone. Int J Radiat Oncol Biol Phys. 1995;32:331–40.PubMedCrossRefGoogle Scholar
  65. 65.
    Coppin CM, Gospodarowicz MK, James K, et al. Improved local control of invasive bladder cancer by concurrent cisplatin and preoperative or definitive radiation. The National Cancer Institute of Canada clinical trials group. J Clin Oncol. 1996;14:2901–7.PubMedCrossRefGoogle Scholar
  66. 66.
    Kaufman DS, Winter KA, Shipley WU, et al. The initial results in muscle-invading bladder cancer of RTOG 95-06: phase I/II trial of transurethral surgery plus radiation therapy with concurrent cisplatin and 5-fluorouracil followed by selective bladder preservation or cystectomy depending on the initial response. Oncologist. 2000;5:471–6.PubMedCrossRefGoogle Scholar
  67. 67.
    Kaufman DS, Winter KA, Shipley WU, et al. Phase I-II RTOG study (99-06) of patients with muscle-invasive bladder cancer undergoing transurethral surgery, paclitaxel, cisplatin, and twice-daily radiotherapy followed by selective bladder preservation or radical cystectomy and adjuvant chemotherapy. Urology. 2009;73:833–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Shipley WU, Winter KA, Kaufman DS, et al. Phase III trial of neoadjuvant chemotherapy in patients with invasive bladder cancer treated with selective bladder preservation by combined radiation therapy and chemotherapy: initial results of radiation therapy oncology group 89-03. J Clin Oncol. 1998;16:3576–83.PubMedCrossRefGoogle Scholar
  69. 69.
    Tester W, Porter A, Asbell S, et al. Combined modality program with possible organ preservation for invasive bladder carcinoma: results of RTOG protocol 85-12. Int J Radiat Oncol Biol Phys. 1993;25:783–90.PubMedCrossRefGoogle Scholar
  70. 70.
    James ND, Hussain SA, Hall E, et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366:1477–88.PubMedCrossRefGoogle Scholar
  71. 71.
    Plimack ER, Hoffman-Censits JH, Viterbo R, et al. Accelerated methotrexate, vinblastine, doxorubicin, and cisplatin is safe, effective, and efficient neoadjuvant treatment for muscle-invasive bladder cancer: results of a multicenter phase II study with molecular correlates of response and toxicity. J Clin Oncol. 2014;32:1895–901.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    von der Maase H, Sengelov L, Roberts JT, et al. Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol. 2005;23:4602–8.Google Scholar
  73. 73.
    Zehnder P, Studer UE, Skinner EC, et al. Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. J Urol. 2011;186:1261–8.PubMedCrossRefGoogle Scholar
  74. 74.
    Mak RH, Hunt D, Shipley WU, et al. Long-term outcomes in patients with muscle-invasive bladder cancer after selective bladder-preserving combined-modality therapy: a pooled analysis of radiation therapy oncology group protocols 8802, 8903, 9506, 9706, 9906, and 0233. J Clin Oncol. 2014;32:3801–9.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration. Eur Urol. 2005;48:202–5; discussion 205-6.Google Scholar
  76. 76.
    Amin MB, Edge SB, Byrd DR, et al. American joint committee on Cancer (AJCC) Cancer staging manual. 8th ed. New York: Springer; 2017.CrossRefGoogle Scholar
  77. 77.
    Escudier B, Bellmunt J, Negrier S, et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol. 2010;28:2144–50.PubMedCrossRefGoogle Scholar
  78. 78.
    Escudier B, Eisen T, Stadler WM, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. 2007;356:125–34.PubMedCrossRefGoogle Scholar
  79. 79.
    Kjaer M, Iversen P, Hvidt V, et al. A randomized trial of postoperative radiotherapy versus observation in stage II and III renal adenocarcinoma. A study by the Copenhagen renal Cancer study group. Scand J Urol Nephrol. 1987;21:285–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Motzer RJ, Basch E. Targeted drugs for metastatic renal cell carcinoma. Lancet. 2007;370:2071–3.PubMedCrossRefGoogle Scholar
  81. 81.
    Stein M, Kuten A, Halpern J, et al. The value of postoperative irradiation in renal cell cancer. Radiother Oncol. 1992;24:41–4.PubMedCrossRefGoogle Scholar
  82. 82.
    Patard JJ, Leray E, Rioux-Leclercq N, et al. Prognostic value of histologic subtypes in renal cell carcinoma: a multicenter experience. J Clin Oncol. 2005;23:2763–71.PubMedCrossRefGoogle Scholar
  83. 83.
    Kang DE, White RL Jr, Zuger JH, et al. Clinical use of fluorodeoxyglucose F 18 positron emission tomography for detection of renal cell carcinoma. J Urol. 2004;171:1806–9.PubMedCrossRefGoogle Scholar
  84. 84.
    Armstrong AJ, George DJ, Halabi S. Serum lactate dehydrogenase predicts for overall survival benefit in patients with metastatic renal cell carcinoma treated with inhibition of mammalian target of rapamycin. J Clin Oncol. 2012;30:3402–7.PubMedCrossRefGoogle Scholar
  85. 85.
    Dalbagni G, Zhang ZF, Lacombe L, et al. Male urethral carcinoma: analysis of treatment outcome. Urology. 1999;53:1126–32.PubMedCrossRefGoogle Scholar
  86. 86.
    Eng TY, Naguib M, Galang T, et al. Retrospective study of the treatment of urethral cancer. Am J Clin Oncol. 2003;26:558–62.PubMedCrossRefGoogle Scholar
  87. 87.
    Heysek RV, Parsons JT, Drylie DM, et al. Carcinoma of the male urethra. J Urol. 1985;134:753–5.PubMedCrossRefGoogle Scholar
  88. 88.
    Krieg R, Hoffman R. Current management of unusual genitourinary cancers. Part 2: urethral cancer. Oncology (Williston Park). 1520;13:1511–7. discussion 1523-4, 1999Google Scholar
  89. 89.
    Fossa SD, Horwich A, Russell JM, et al. Optimal planning target volume for stage I testicular seminoma: a Medical Research Council randomized trial. Medical Research Council testicular tumor working group. J Clin Oncol. 1999;17:1146.PubMedCrossRefGoogle Scholar
  90. 90.
    Jones WG, Fossa SD, Mead GM, et al. Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: a report on Medical Research Council trial TE18, European organisation for the research and treatment of Cancer trial 30942 (ISRCTN18525328). J Clin Oncol. 2005;23:1200–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Oliver RT, Mason MD, Mead GM, et al. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial. Lancet. 2005;366:293–300.PubMedCrossRefGoogle Scholar
  92. 92.
    Brydoy M, Fossa SD, Klepp O, et al. Paternity following treatment for testicular cancer. J Natl Cancer Inst. 2005;97:1580–8.PubMedCrossRefGoogle Scholar
  93. 93.
    Classen J, Schmidberger H, Meisner C, et al. Radiotherapy for stages IIA/B testicular seminoma: final report of a prospective multicenter clinical trial. J Clin Oncol. 2003;21:1101–6.PubMedCrossRefGoogle Scholar
  94. 94.
    Fossa SD, Cvancarova M, Chen L, et al. Adverse prognostic factors for testicular cancer-specific survival: a population-based study of 27,948 patients. J Clin Oncol. 2011;29:963–70.PubMedCrossRefGoogle Scholar
  95. 95.
    Hamilton CR, Horwich A, Bliss JM, et al. Gastrointestinal morbidity of adjuvant radiotherapy in stage I malignant teratoma of the testis. Radiother Oncol. 1987;10:85–90.PubMedCrossRefGoogle Scholar
  96. 96.
    Kollmannsberger C, Tandstad T, Bedard PL, et al. Patterns of relapse in patients with clinical stage I testicular cancer managed with active surveillance. J Clin Oncol. 2015;33:51–7.PubMedCrossRefGoogle Scholar
  97. 97.
    Mortensen MS, Lauritsen J, Gundgaard MG, et al. A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol. 2014;66:1172–8.PubMedCrossRefGoogle Scholar
  98. 98.
    Paly JJ, Efstathiou JA, Hedgire SS, et al. Mapping patterns of nodal metastases in seminoma: rethinking radiotherapy fields. Radiother Oncol. 2013;106:64–8.PubMedCrossRefGoogle Scholar
  99. 99.
    Shamash J, Powles T, Wilson P, et al. Prognostic factors in cytokine-refractory renal cell carcinoma treated with irinotecan, Cisplatin, and mitomycin chemotherapy. J Clin Oncol. 2005;23:1323–5.PubMedCrossRefGoogle Scholar
  100. 100.
    Travis LB, Fossa SD, Schonfeld SJ, et al. Second cancers among 40,576 testicular cancer patients: focus on long-term survivors. J Natl Cancer Inst. 2005;97:1354–65.PubMedCrossRefGoogle Scholar
  101. 101.
    Willemse PM, Burggraaf J, Hamdy NA, et al. Prevalence of the metabolic syndrome and cardiovascular disease risk in chemotherapy-treated testicular germ cell tumour survivors. Br J Cancer. 2013;109:60–7.PubMedPubMedCentralCrossRefGoogle Scholar
  102. 102.
    International Germ Cell Consensus Classification. A prognostic factor-based staging system for metastatic germ cell cancers. International germ cell Cancer collaborative group. J Clin Oncol. 1997;15:594–603.CrossRefGoogle Scholar
  103. 103.
    Bieri S, Rouzaud M, Miralbell R. Seminoma of the testis: is scrotal shielding necessary when radiotherapy is limited to the Para-aortic nodes? Radiother Oncol. 1999;50:349–53.PubMedCrossRefGoogle Scholar
  104. 104.
    Bruns F, Bremer M, Meyer A, et al. Adjuvant radiotherapy in stage I seminoma: is there a role for further reduction of treatment volume? Acta Oncol. 2005;44:142–8.PubMedCrossRefGoogle Scholar
  105. 105.
    Warde P, Specht L, Horwich A, et al. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002;20:4448–52.PubMedCrossRefGoogle Scholar
  106. 106.
    Daugaard G, Petersen PM, Rorth M. Surveillance in stage I testicular cancer. APMIS. 2003;111:76–83.; discussion 83-5.PubMedCrossRefGoogle Scholar
  107. 107.
    Aparicio J, Maroto P, del Muro XG, et al. Risk-adapted treatment in clinical stage I testicular seminoma: the third Spanish germ cell Cancer group study. J Clin Oncol. 2011;29:4677–81.PubMedCrossRefGoogle Scholar
  108. 108.
    Bokemeyer C, Nichols CR, Droz JP, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: results from an international analysis. J Clin Oncol. 2002;20:1864–73.PubMedCrossRefGoogle Scholar
  109. 109.
    Crook JM, Jezioranski J, Grimard L, et al. Penile brachytherapy: results for 49 patients. Int J Radiat Oncol Biol Phys. 2005;62:460–7.PubMedCrossRefGoogle Scholar
  110. 110.
    Grabstald H, Kelley CD. Radiation therapy of penile cancer: six to ten-year follow-up. Urology. 1980;15:575–6.PubMedCrossRefGoogle Scholar
  111. 111.
    Krieg RM, Luk KH. Carcinoma of penis. Review of cases treated by surgery and radiation therapy 1960-1977. Urology. 1981;18:149–54.PubMedCrossRefGoogle Scholar
  112. 112.
    Mazeron JJ, Langlois D, Lobo PA, et al. Interstitial radiation therapy for carcinoma of the penis using iridium 192 wires: the Henri Mondor experience (1970-1979). Int J Radiat Oncol Biol Phys. 1984;10:1891–5.PubMedCrossRefGoogle Scholar
  113. 113.
    McLean M, Akl AM, Warde P, et al. The results of primary radiation therapy in the management of squamous cell carcinoma of the penis. Int J Radiat Oncol Biol Phys. 1993;25:623–8.PubMedCrossRefGoogle Scholar
  114. 114.
    Sarin R, Norman AR, Steel GG, et al. Treatment results and prognostic factors in 101 men treated for squamous carcinoma of the penis. Int J Radiat Oncol Biol Phys. 1997;38:713–22.PubMedCrossRefGoogle Scholar
  115. 115.
    Miralles-Guri C, Bruni L, Cubilla AL, et al. Human papillomavirus prevalence and type distribution in penile carcinoma. J Clin Pathol. 2009;62:870–8.PubMedCrossRefGoogle Scholar
  116. 116.
    Zouhair A, Coucke PA, Jeanneret W, et al. Radiation therapy alone or combined surgery and radiation therapy in squamous-cell carcinoma of the penis? Eur J Cancer. 2001;37:198–203.PubMedCrossRefGoogle Scholar
  117. 117.
    Crook J, Grimard L, Tsihlias J, et al. Interstitial brachytherapy for penile cancer: an alternative to amputation. J Urol. 2002;167:506–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nicholas G. Zaorsky
    • 1
    Email author
  • Daniel M. Trifiletti
    • 2
  • Katherine Tzou
    • 2
  1. 1.Penn State Cancer InstituteHersheyUSA
  2. 2.Mayo ClinicJacksonvilleUSA

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