This testicular cancer management guide covers the diagnosis, staging, and treatment of germ-cell tumors and seminoma.
Mark K. Buyyounouski, MD, MS
Androgen deprivation therapy (ADT) has been shown to be beneficial in combination with radiotherapy (RT) vs RT alone in multiple phase III randomized trials treating patients with high-risk prostate cancer. Drs. Fang, Merrick, and Wallner have concisely summarized the data in Table 1 of their article. The Radiation Therapy Oncology Group trial RTOG 86-10 has demonstrated that as little as 4 months of ADT in combination with RT can delay the time to development of metastatic disease by up to 8 years, compared with RT alone. What’s more, longer durations of ADT (ie, 28 to 36 months) are superior to shorter durations (4 to 6 months), as evidenced by the results of RTOG 92-02 and the European Organisation for Research and Treatment of Cancer trial EORTC 22961. Therefore, a long-term duration of ADT (ie, 24 to 36 months) is an accepted standard of care in combination with RT for patients with high-risk disease.
Adjuvant radiotherapy to the regional lymph nodes following orchiectomy has been the standard of care for seminoma for over 50 years. The ipsilateral hemipelvis, retroperitoneum, and mediastinum were all regions thought to be important for reducing the risk of recurrence.