Klin Onkol 2008; 21(3): 86-92.
About 35% of men with malignant testicular germ cell cancer are diagnosed with seminoma, up to 80% of them with stage I disease. The number of men succesfully treated reaches 100%. For many years radiotherapy following radical orchiectomy was considered the golden standard for treatment. Treatment effi ciency of radiotherapy is limited by it’s late sequlae, notably gastrointestinal diseases, second cancer development, cardiovascular toxicity or infertility. Therefore there has been an effort made to minimalise this late toxicity – by radiation fi eld reduction, radiation dose reduction, surveilance or chemotherapy with carboplatine as a single agent. According to available studies the effi ciency of radiotherapy reduced either in fi eld area or dose are as effi cient as previously used radiation regimens and is as effi cient as adjuvant chemotherapy with carboplatine. On the other hand the results of surveillance studies are comparable to those of active therapies, especially in patients with contra-indications to active treatment especially without prognostic risk factors, i.e. tumour size >4cm, invasion to rete testis, pre – operative elevation of tumoru markers (beta HCG). All of the above described treatment modalities (adjuvant radiotherapy or chemotherapy and surveillance of patients without risk factors) reach comparable 5 years‘ survival from 93,1% in surveillance to 96% in patients after radiotherapy or chemotherapy. Nowadays, according to the new NCCN guidelines 2008,
we have several options for management strategies for post – orchiectomy treatment, i.e. adjuvant radiotherapy, surveillance and newly also adjuvant carboplatine – based chemotherapy. In our review article we discuss advantages and disadvantages of the various treatment modalities.
