Long-term outcomes following post-operative radiotherapy for Stage I/II testicular seminoma - an Australasian single-institution experience

Our plain-English summary of Long-term outcomes following post-operative radiotherapy for Stage I/II testicular seminoma - an Australasian single-institution experience, by W.L. Ong, L. Nazareth, B. Hindson, et al (Journal of Medical Radiation Sciences, 2016).

The study

• Authors: W.L. Ong, L. Nazareth, B. Hindson, B. Matheson, J.L. Millar
• Journal: Journal of Medical Radiation Sciences
• Published: 2016;63(3):161-9
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The aim of the study is to review the long-term oncological outcomes and adverse effects of post-operative radiotherapy (PORT) for Stage I/II seminoma patients in an Australian radiation treatment centre.

Methods: This is a retrospective study of 125 patients with Stage I/II seminoma treated with PORT at the Alfred Health Radiation Oncology Service between 1992 and 2013. Patients were linked to the Victorian Cancer Registry to enable confirmation of survival and diagnosis of secondary malignancies (SM). The relapse-free survival (RFS), testicular-cancer-specific survival (TCSS), overall survival (OS) and SM-free survival (SMFS) were estimated with Kaplan-Meier methods.

Results: The median age at diagnosis was 36 (range 20-62). The median time between diagnosis and PORT was 1.6 months (range: 0.5-4.5). Fifty patients (40%) had PORT to the para-aortic (PA) target alone, while the remaining had PORT to PA and ipsilateral or bilateral iliac lymph nodes. There were no acute adverse effects requiring admission. The median follow-up after PORT was 7.8 years (range = 0.1-19.1). There were two relapses, both of which occurred within 1 year of PORT (estimated 10-year RFS = 98.4%). Five deaths were reported, none of which were testicular cancer-related death (estimated 10-year TCSS = 100%, 10-year OS = 97.3%). There were seven SM (one lower lip cancer, one upper shoulder melanoma, one mesothelioma, two prostate cancer, one acute myeloid leukaemia and one contralateral testicular seminoma) reported in six patients, with estimated 10-year SMFS of 92.9%.

Conclusion: Our series confirms excellent oncological outcomes among patients with Stage I/II seminoma treated with PORT, with uncommon occurrence of SM.

In plain English

This was a retrospective study of 125 men with Stage I or Stage II testicular seminoma, 106 Stage I and 19 Stage II. All had radiotherapy after surgery at the Alfred Health Radiation Oncology Service in Victoria, Australia, between 1992 and 2013. Records were linked to the Victorian Cancer Registry to confirm deaths and later cancers. Median follow-up was 7.8 years. No man had an immediate side effect needing hospital admission. Two men had their seminoma return, both within a year, for an estimated 10-year relapse-free survival of 98.4%. Five men died, none from testicular cancer, for an estimated 10-year overall survival of 97.3%. Seven new cancers were found in six men. One was a mesothelioma, called pulmonary mesothelioma in the text. It was diagnosed in October 2008 in a Stage II patient whose seminoma was diagnosed in October 2005. The article did not study asbestos and did not discuss what caused this mesothelioma. The authors concluded that disease control was high and new cancers were uncommon in the first decade. They noted that late effects may build up over later decades.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective single-institution study (case series of all treated patients) with cancer registry linkage
• Who was studied: 125 men with Stage I (106) or Stage II (19) testicular seminoma treated with post-operative radiotherapy at Alfred Health Radiation Oncology Service, Victoria, Australia, 1992 to 2013, out of 169 referred. Median age at diagnosis was 36 (range 20 to 62).
• Exposure: Post-operative external beam radiotherapy to the para-aortic lymph nodes alone (40%) or to the para-aortic plus iliac lymph nodes. Stage I: median 25 Gy over 20 fractions. Stage II: median 35 Gy over 25 fractions. Asbestos exposure was not studied.
• Main results:
  • No acute adverse reaction required hospital admission after radiotherapy (all 125 patients).
  • Two of 125 patients relapsed, both within 1 year of radiotherapy. Estimated 10-year relapse-free survival was 98.4%.
  • Five deaths occurred in the cohort, none related to testicular cancer. Estimated 10-year testicular-cancer-specific survival was 100% and overall survival was 97.3%.
  • Seven second malignancies occurred in six patients at a median of 5.6 years after radiotherapy (range 0.3 to 8.9 years). Estimated 10-year second-malignancy-free survival was 92.9%.
  • One of the second malignancies was a mesothelioma, described in the results text as pulmonary mesothelioma. Per Table 2, the patient had Stage II seminoma diagnosed in October 2005 and was treated to the para-aortic and bilateral iliac nodes (35 Gy in 28 fractions). The mesothelioma was diagnosed in October 2008.
  • One cardiovascular event was observed: a stroke 18 months after radiotherapy in a patient with known heart disease. One gastrointestinal event was observed: peptic ulcer disease.
• The authors' conclusion: The authors concluded that radiotherapy after surgery gave high rates of disease control for Stage I/II seminoma, with low incidence of second malignancies within the first decade. They added that late effects may accumulate in later decades.
• Limitations the authors state:
  • Because the study was retrospective, cardiovascular events managed at other hospitals may not have been recorded.
  • The strict definition of cardiovascular toxicity may have led to under-reporting.
  • The men were relatively young and median follow-up was under 8 years, which is short for observing late cardiovascular effects.
  • Patients who moved overseas could have been missed by registry linkage.

Topics

Medical terms in this study, explained in our Lexicon: Cancer Registry, Overall Survival, Bilateral, Mesothelioma.

Related studies

• Colon cancers and peritoneal mesothelioma occurring 29 years after abdominal radiation for testicular seminoma. A case report and review of the literature — D. Tassile, A.D. Roth, et al. (1998)
• Malignant peritoneal mesothelioma associated with deep vein thrombosis following radiotherapy for seminoma of the testis — F. Sato, H. Yamazaki, et al. (2000)
• Risk of mesothelioma following external beam radiotherapy for prostate cancer: a cohort analysis of SEER database — A. Farioli, F.S. Violante, et al. (2013)
• Malignant peritoneal mesothelioma following radiotherapy for seminoma of the testis — R.J. Stock, Y.S. Fu, et al. (1979)
• Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) with cisplatin in pediatric patients with peritoneal mesothelioma: a single institution experience and long term follow up — P. Malekzadeh, M. Good, et al. (2021)
• Long-term outcomes of intensity-modulated radiotherapy following extra-pleural pneumonectomy for malignant pleural mesothelioma — Y. Matsuo, K. Shibuya, et al. (2017)

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