Is There Still an Indication for Radiotherapy in Seminoma Clinical Stages I–IIA/B?

  • Sophie Dorothea FossåEmail author
  • Klaus-Peter Dieckmann


In spite of the high radiosensitivity of seminoma, radiotherapy should be used only exceptionally in these patients due to the risk of radiation-induced second cancer. Adjuvant chemotherapy with carboplatin or active surveillance represents effective alternative therapeutic options in stage I. For patients with limited stage II, radiotherapy may be considered though cisplatin-based chemotherapy is the treatment preferred by most European clinicians.


Active Surveillance Testicular Cancer Target Field Germ Cell Cancer Adjuvant Treatment Strategy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Barringer BS, Stewart FW, Spies JW. Testicular neoplasms: the relation between the pathologic histology, clinical course and reaction to irradiation in testicular neoplasms. Ann Surg. 1930;91:115–22.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Fosså 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.PubMedGoogle Scholar
  3. 3.
    Jones WG, Fosså 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.CrossRefPubMedGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 5.
    Classen JH, Schmidberger C, Meisner C, et al. Para-aortic irradiation for stage I testicular seminoma: results of a prospective study in 675 patients. A trial of the German testicular cancer study group (GTCSG). Br J Cancer. 2004;90:2305–11.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Mead GM, Fossa SD, Oliver RT, et al. Randomized trials in 2466 patients with stage I seminoma: patterns of relapse and follow-up. J Natl Cancer Inst. 2011;103:241–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Warde P, Huddart R, Bolton D, et al. Management of localized seminoma, stage I-III: SIU/ICUD consensus meeting on germ cell tumors (GCT), Shanghai 2009. Urology. 2011;78:435–43.CrossRefGoogle Scholar
  8. 8.
    Dieckmann KP, Albers P, Classen J, et al. Late relapse of testicular germ cell neoplasms: a descriptive analysis of 122 cases. J Urol. 2005;173:824–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Chung P, Mayhew LA, Warde P, et al. Management of stage I seminomatous testicular cancer: a systematic review. Clin Oncol (R Coll Radiol). 2010;22:6–16.CrossRefGoogle Scholar
  10. 10.
    Powles T, Robinson D, Shamash J, et al. The long-term risks of adjuvant carboplatin treatment for stage I seminoma of the testis. Ann Oncol. 2008;19:443–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Steiner H, Scheiber K, Berger AP, Rein P, Hobisch A, Aufderklamm J, Pilloni S, Stoehr B, Aigner F, Fritzer A, Zangerl F. Retrospective multicentre study of carboplatin monotherapy for clinical stage I seminoma. BJU Int. 2011;107:1074–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Groll RJ, Warde P, Jewett MAS. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol. 2007;64:182–97.CrossRefPubMedGoogle Scholar
  13. 13.
    Tanstad T, Smaaland R, Solberg A, et al. Management of seminomatous testicular cancer: a binational prospective population-based study from the Swedish Norwegian testicular cancer study group. J Clin Oncol. 2011;29:719–25.CrossRefGoogle Scholar
  14. 14.
    Mortensen MS, Lauritsen J, Gundgaard MG, Agerbæk M, Holm NV, Christensen IJ, von der Maase H, Daugaard G. A nationwide cohort study of stage I seminoma patients followed on a surveillance program. Eur Urol. 2014; pii: S0302-2838(14)00629-0. doi: 10.1016/j.eururo.2014.07.001. [Epub ahead of print].Google Scholar
  15. 15.
    Albers P, Albrecht W, Algaba F, et al. EAU guidelines on testicular cancer: 2011 update. Eur Urol. 2011;60:304–19.CrossRefPubMedGoogle Scholar
  16. 16.
    Tarin TV, Sonn G, Shinghal R. Estimating the risk of cancer associated with imaging related radiation during surveillance for stage I testicular cancer using computerized tomography. J Urol. 2009;181:627–32.CrossRefPubMedGoogle Scholar
  17. 17.
    Grimison P, Houghton B, Chatfield M, et al. Patterns of management and surveillance imaging amongst medical oncologists in Australia for stage I testicular cancer. BJU Int. 2013;112:35–43.CrossRefGoogle Scholar
  18. 18.
    Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.CrossRefPubMedGoogle Scholar
  19. 19.
    Cathomas R, Helbling D, Stenner F, et al. Interdisciplinary evidence-based recommendations for the follow-up of testicular cancer patients: a joint effort. Swiss Med Wkly. 2010;140:356–69.PubMedGoogle Scholar
  20. 20.
    Grubnic S, Vinnicombe SJ, Norman AR, Husband JE. MR evaluation of normal retroperitoneal and pelvic lymph nodes. Clin Radiol. 2002;57:193–200.CrossRefPubMedGoogle Scholar
  21. 21.
    Wit R, Bosl GJ. Optimal management of clinical stage I testis cancer: one size does not fit all. J Clin Oncol. 2013;31:3477–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Yu HY, Madison RA, Setodji CM, Saigal CS. Quality of surveillance for stage I testis cancer in the community. J Clin Oncol. 2009;27:4327–32.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Rusner C, Stang A, Dieckmann KP, Friedel H. Frequency of computed tomography examinations in the follow-up care of testicular cancer patients – an evaluation of patterns of care in Germany. Onkologie. 2013;36:188–92.CrossRefPubMedGoogle Scholar
  24. 24.
    Dieckmann KP, Brüggeboes B, Pichlmeier U, et al. Adjuvant treatment of clinical stage I seminoma: is a single course of carboplatin sufficient? Urology. 2000;55:102–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Zagars GK, Ballo MT, Lee AK, Strom SS. Mortality after cure of testicular seminoma. J Clin Oncol. 2004;22:640–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Travis LB, Fosså 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.CrossRefPubMedGoogle Scholar
  27. 27.
    Beard CJ, Travis LB, Chen MH, et al. Outcomes in stage I testicular seminoma: a population-based study of 9193 patients. Cancer. 2013;119:2771–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Horwich A, Fossa SD, Huddart R, et al. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer. 2014;110:256–63.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Dieckmann KP. Seminoma stage 1: patterns of care in Europe. BJU Int. 2013;111:10–1.CrossRefGoogle Scholar
  30. 30.
    Ahmed KA, Wilder RB. Outcomes and treatment patterns as a function of time in stage IS testicular seminoma: a population-based analysis. Cancer Epidemiol. 2014;38:124–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Arvold ND, Catalano PJ, Sweeney CJ, et al. Barriers to the implementation of surveillance for stage I testicular seminoma. Int J Radiat Oncol Biol Phys. 2012;84:383–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Vossen CY, Horwich A, Daugaard G, et al. Patterns of care in the management of seminoma stage I: results from a European survey. BJU Int. 2012;110:524–31.CrossRefPubMedGoogle Scholar
  33. 33.
    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.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    Beyer J, Albers P, Altena R, et al. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol. 2013;24:878–88.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Ruf CG, Dinger D, Port M, et al. Small RNAs in the peripheral blood discriminate metastasized from non-metastasized seminoma. Mol Cancer. 2014;13:47.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Ruf CG, Linbecker M, Port M, et al. Predicting metastasized seminoma using gene expression. BJU Int. 2012;190:1046–51.Google Scholar
  38. 38.
    Hallemeier CL, Pisansky TM, Davis BJ, Choo R. Long-term outcomes of radiotherapy for stage II testicular seminoma-the Mayo Clinic experience. Urol Oncol. 2013;31:1832–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Garcia-Del-Muro X, Maroto P, Guma J, et al. Chemotherapy as an alternative to radiotherapy in the treatment of stage IIA and IIB testicular seminoma: a Spanish Germ Cell Cancer Group Study. J Clin Oncol. 2008;26:5416–21.CrossRefPubMedGoogle Scholar
  40. 40.
    Kollmannsberger C, Tyldesley S, Moore C, et al. Evolution in management of testicular seminoma: population-based outcomes with selective utilization of active therapies. Ann Oncol. 2011;22:808–14.CrossRefPubMedGoogle Scholar
  41. 41.
    Horwich A, Dearnaley DP, Sohaib A, et al. Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann Oncol. 2013;24:2104–210.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Sophie Dorothea Fosså
    • 1
    Email author
  • Klaus-Peter Dieckmann
    • 2
  1. 1.Oslo University Hospital, The Norwegian Radium Hospital, National Advisory Unit for Late Effects after Cancer TherapyOslo NydalenNorway
  2. 2.Department of UrologyAlbertinen-KrankenhausHamburgGermany

Personalised recommendations