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Testicular germ cell tumour arising 15 years after radiotherapy with 18 Gy for germ cell neoplasia in situ

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Abstract

Purpose

Germ cell neoplasia in situ (GCNis), the precursor of adult testicular germ cell tumours (GCTs), is found in 5–6% of contralateral testicles in patients with testicular GCT and in the tumour-surrounding tissue of > 90% of testes undergoing testis-sparing surgery (TSS) for GCT. Local radiotherapy to the testis with 18–20 Gy eradicates GCNis while preserving Leydig cells. The frequency of treatment failures is so far unknown.

Methods

A 22-year-old patient with right-sided seminoma clinical stage I and contralateral GCNis received radiotherapy with 18 Gy to his left testicle. Fifteen years later he underwent orchiectomy of the irradiated testis for seminoma with adjacent GCNis. The patient is well 1 year postoperatively while on testosterone-replacement therapy. The literature was searched for further cases with GCTs arising despite local radiotherapy.

Results

Six failures of radiotherapy have been reported previously. An estimated total number of 200 and 100 radiotherapeutic regimens with 18–20 Gy applied to cases with contralateral GCNis and with TSS, respectively, are documented in the literature.

Conclusion

Cumulative experience suggests that radiotherapy with 18–20 Gy to the testis may fail with an estimated frequency of around 1%. Reasons for failure are elusive. A primary radioresistant subfraction of GCNis is hypothesized as well as technical failures regarding application of the radiotherapeutic dose volume in small and mobile testes. Caregivers of patients with TSS and contralateral GCNis should be aware of local relapses occurring after intervals of > 10 years.

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Funding

There was no funding with regard to the present work

Author information

Authors and Affiliations

  1. Urologische Abteilung, Hodentumorzentrum, Asklepios Klinik Altona, Paul Ehrlich Str. 1, 22763, Hamburg, Germany

    Klaus-Peter Dieckmann, Mathias Angerer & Christian Wülfing

  2. Hermann Holthusen Institut für Strahlentherapie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

    Silke Tribius

  3. Klinik und Poliklinik für Dermatologie und Venerologie Bereich Andrologie, Universitätsklinikum Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Andrea Salzbrunn & Kathrein von Kopylow

  4. MVZ Hanse Histologikum, Fangdieckstr. 75a, 22547, Hamburg, Germany

    Martin Mollenhauer

Authors
  1. Klaus-Peter Dieckmann
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  2. Silke Tribius
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  3. Mathias Angerer
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  4. Andrea Salzbrunn
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  5. Kathrein von Kopylow
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  6. Martin Mollenhauer
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  7. Christian Wülfing
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Silke Tribius, Mathias Angerer, Klaus-Peter Dieckmann, Kathrein von Kopylew, Andrea Salzbrunn, Martin Mollenhauer and Christian Wülfing. The first draft of the manuscript was written by Klaus-Peter Dieckmann, Silke Tribius and Mathias Angerer, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Klaus-Peter Dieckmann.

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Conflict of interest

K.‑P. Dieckmann, S. Tribius, M. Angerer, A. Salzbrunn, K. von Kopylow, M. Mollenhauer and C. Wülfing declare that they have no competing interests.

Ethical standards

No formal ethical approval was sought because all treatment procedures applied in the present patient fully conformed with current guidelines. Consent: The patient reported herein gave written consent for publication of the details of his medical case in anonymous form.

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Data availability

All clinical data are available from the first author upon reasonable request.

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Dieckmann, KP., Tribius, S., Angerer, M. et al. Testicular germ cell tumour arising 15 years after radiotherapy with 18 Gy for germ cell neoplasia in situ. Strahlenther Onkol 199, 322–326 (2023). https://doi.org/10.1007/s00066-022-02025-x

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  • DOI: https://doi.org/10.1007/s00066-022-02025-x

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