ABSTRACT

About 80% of men with testicular seminoma are diagnosed with stage I disease. For many years, the standard treatment for this patient group has been radiation to paraaortic and ipsilateral pelvic lymph nodes after orchiectomy. However, pelvic radiotherapy is unnecessary in patients without prior inguinal or scrotal surgery. Furthermore, in recent years, other treatment modalities for this patient group have evolved. The use of single agent carboplatin has shown promising results, similar to the effects obtained by radiotherapy. In addition, surveillance after primary orchiectomy with no additional treatment is found to be a safe management for many of these patients. On the basis of new information about primary tumor risk factors like rete testis invasion and tumor size, it is now possible to identify patients at a particular high risk of relapse. This will be a helpful tool to identify patients who can be safely included into a surveillance program, and those who could have adjuvant treatment. The final decision about treatment will depend on risk factors, capacity of health care system and patient's own preferences. In our country, with the current problems in patient follow up and the additional cost of a follow up protocol to the healthcare, we think that the postoperative radiotherapy to smaller volumes with doses effective enough to eradicate the subclinic disease is still the gold standard for early stage testicular seminoma.