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What is the value of routine follow-up in stage I seminoma after paraaortic radiotherapy?

An analysis of the German Testicular Cancer Study Group (GTCSG) in 675 prospectively followed patients

Welchen Stellenwert hat die Nachsorge nach paraaortaler Strahlentherapie im Stadium I des Seminoms? Ergebnisse einer Studie der German Testicular Cancer Study Group (GTCSG) bei 675 prospektiv beobachteten Patienten

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Background and Purpose:

Routine posttreatment surveillance is recommended after adjuvant radiotherapy for stage I seminoma. However, systematic studies on the value of follow-up in these patients are missing. This report addresses the efficiency of routine follow-up in stage I seminoma with particular reference to the mode of detection of relapse and the costs of posttreatment screening.

Patients and Methods:

All follow-up investigations of a prospectively followed cohort of 675 patients with stage I seminoma treated with PA radiotherapy were analyzed with respect to the first indications of relapse, patterns of recurrence, risk factors of relapse, and cost-efficiency of the different technical examinations of the follow-up schedule over a 10-year period.


With a median time to follow-up of 61 months, recurrence was diagnosed by symptoms or physical examination in 14 out of 26 relapsing patients. Among the technical follow-up investigations abdominopelvic imaging had the highest detection rate for relapse, while thoracic imaging and marker analysis were inefficient. Abdominal sonography had the highest cost-efficiency of all technical follow-up investigations, while computed tomography (CT) scans were responsible for approximately 60% of all costs. The authors failed to identify risk factors predictive of relapse after adjuvant irradiation.


Routine technical investigations during follow-up after PA radiotherapy for stage I seminoma yield only a low detection rate of relapse from cancer. The data presented here provide no evidence for the value of technical follow-up beyond the 3rd year after treatment or routine screening of the chest. Thorough physical examination of the patients should be encouraged. Patients should be informed about potential symptoms indicative of recurrence. Restrictive use of abdominopelvic CT scans will reduce exposure to ionizing radiation and considerably increase the cost-efficiency of follow-up.

Hintergrund und Ziel:

Nach adjuvanter Strahlentherapie von Seminompatienten im Stadium I wird eine Nachsorge empfohlen, systematische Studien für diese Empfehlungen fehlen jedoch. Ziel dieser Arbeit ist es, den Nutzen der Nachsorgeuntersuchungen in Bezug auf den Rezidivnachweis und die Kosten zu analysieren.

Patienten und Methodik:

Es wurde eine retrospektive Analyse einer 675 Patienten umfassenden Patientengruppe mit Seminom im Stadium I durchgeführt, die im Rahmen einer prospektiven Studie eine paraaortale Strahlentherapie erhalten hatten und systematisch nachbeobachtet worden waren. Folgende Aspekte wurden analysiert: Art des Rezidivnachweises (klinisch/symptomatisch oder durch technische Untersuchungen), Rezidivmuster (anatomisch und zeitlich), Risikofaktoren für das Auftreten eines Rezidivs, Kosten der Nachsorge.


Nach einer medianen Nachbeobachtungszeit von 61 Monaten traten 26 Rezidive auf. Bei 14 Patienten ergab sich der erste Hinweis auf den Rückfall durch Symptome oder Befunde der körperlichen Untersuchung. Von den technischen Untersuchungen wies die abdominopelvine Bildgebung die höchste Nachweisrate von Rezidiven auf, während Thoraxbildgebung und Tumormarkerbestimmung eine geringe Nachweiswahrscheinlichkeit hatten. Die Abdomensonographie zeigte die beste Kosten-Nutzen- Relation, während die Computertomographie (CT) etwa 60% der Kosten des Nachsorgeprogramms verursachte. Risikofaktoren für das Auftreten eines Rezidivs konnten nicht nachgewiesen werden.


Diese Ergebnisse weisen darauf hin, dass der Routineeinsatz technischer Untersuchungen eine geringe Detektionsrate von Rezidiven nach paraaortaler Strahlentherapie im Stadium I des Seminoms hat und nach dem 3. Jahr nicht mehr erfolgen sollte. Ein restriktiver Einsatz der CT kann die Kosten-Nutzen-Relation der Nachsorge deutlich verbessern.

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Correspondence to Johannes Claßen.

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Claßen, J., Schmidberger, H., Souchon, R. et al. What is the value of routine follow-up in stage I seminoma after paraaortic radiotherapy?. Strahlenther Onkol 185, 349–354 (2009).

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