Treatment of Stage I Seminoma.
Stage I testicular seminoma is a curable condition. The primary treatment is high inguinal orchiectomy. The treatment options after surgery includes radiotherapy, chemotherapy with single agent carboplatin and active surveillance. Radiotherapy has evolved over the past decades with reduced treatment volume and radiation dose without compromising the outcome.
Para aortic strip radiation 20 Gy in 10 fractions is equivalent to single agent carboplatin. Active surveillance is an acceptable approach for patients without adverse factors. There is no data comparing treatment versus active surveillance till date. This article reviews the evidences for each approach. Testicular cancer constitutes 1-2% of all cancers in men. The age standardized incidence varies from 0.6 in Asia to 12.2 in Norway per 100,000 men.
Testicular Germ Cell Tumors are broadly classified into Seminoma and Non-seminoma groups. They represent one among the few curable malignancies. Their exquisite sensitivity to chemotherapy and radiation is the reason behind the success story. Pure seminoma accounts for nearly half of all diagnosed GCT and appear increasing.
The median age at presentation is around 40 years, a decade later than non-seminoma. Stage I seminoma refers to disease limited to testis with normal tumor markers. The options available for stage I seminoma after orchiectomy are chemotherapy, radiotherapy or active surveillance.
This has given rise to a debate of selecting the optimal treatment strategy. Most often patients with testicular tumor present with discomfort or swelling in the scrotum. If an intratesticular mass is suspected, an ultrasound of the scrotumaids in confirming the diagnosis as well as evaluate the contralateral testis.
βHCG can be produced by both seminomatous and nonseminomatous tumors, but AFP is produced by non-seminomatous tumors only. If the pathological diagnosis is pure seminoma with elevated pre-operative AFP, then it must be considered and treated as non-seminoma.