stage 1 seminoma radiation or surveillance??

[cbuysse]

I was diagnosed with TC 5/3/06 and had an orchiectomy on 5/5/06. Pathology came back classical pure seminoma. No vascular invasion, the tumor was confined to the testis and 1.5cm according to report. I am not sure why the report does not give further dimensions. I am 35 yrs old and turn 36 in 2 weeks. All blood work for markers was normal.
My question is one I am sure many grapple with and that is to do the adjuvant radiation treatment or just do surveillance. I am afraid there is no clear cut answer to that but it is all I think about as my appt with the Rad. Oncologist is this coming Wednesday. Any input or studies that you may know of that might help me in this decision would be greatly appreciated.
One piece of info I have searched and searched for but have not been able to find is what percentage of Stage1 seminoma patients that chose surveillance ultimately have to do Chemo because of a reoccurrence, not radiation but Chemo. I guess that is my greatest fear; to choose the surveillance and end up having to do Chemo. Thanks!

[UK Mart]

You're in a similar situation to myself although a 1.5cm tumour does seem as though you caught it really early! In the UK, they give you radiation as a matter of course for those of us in this position (stage one seminoma, no evidence of spread). I was a bit concerned that it was unecessary due to secondary cancer issues that have been associated with radiotherapy. Having thought about it a lot, the dose they are giving me is relatively low and also very focused on a limited area so i'm hoping that with technological advancements, the current radiation we receive as a precaution, has benefits that outweigh the risks.

The flip side of surveillance in my opinion, is to have an increased chance of TC returning and then be faced with the heavier duty chemo rather than the lesse radiotherapy now.

This is just my twopenneth and i'd like to stress that I'm no expert, but I'm due to be radiated (is that the term?!) next week.

Keep us posted as to what you choose - it is a tricky decision and like you say, there is any right or wrong answer!

Good luck!

[tc2006]

I am in a similar situation right now (see my post under tc2006), except my tumor was a lot bigger (>5cm). I don't know of any study that compares surveillance people with radiation people, what I have seen is a study that compares radiation people with the general population - to determine whether the radiation TC people have an increased long term risk for 2nd cancer compared with the general population (which, not surprisingly, they do). I've been told that there are surveillance people that have done radiation instead of chemo after relapse, but I think this is rare too - it has to do with the fact that relapses tend to be more 'systemic', i.e. not localized, and chemo seems to be the better choice then. Please keep us posted as to how you decide. Good luck.

[Scott]

While I haven't been able to find statistics, it's my understanding that a recurrence of seminoma in the retroperitoneal lymph nodes of less than 3 cm is typically treated with radiation therapy, while larger nodes or spread to other parts of the body are treated with chemotherapy instead.

[Fish]

While I haven't been able to find statistics, it's my understanding that a recurrence of seminoma in the retroperitoneal lymph nodes of less than 3 cm is typically treated with radiation therapy, while larger nodes or spread to other parts of the body are treated with chemotherapy instead. by Scott

Scott's information is basically what I was told when I was faced with this choice 2.5 years ago.

I chose surveillance.
Low risk factors for recurrence of seminoma
1. age > 35
2. no angiolymphatic invasion
3. tumor size < 4 cm

I met all three of these low risk factors, but ultimately, my decision came down the the fact that there was no evidence of cancer in my body after the I/O, and before I exposed myself to radiation, i had to KNOW it was necessary.

It's not an easy decision and if you go the surveillance route you have to ABSOLUTELY stick to your schedule for testing.

Best wishes,

Jim

[Pau]

I am exactly in the same boat as of today. I just got my pathology report after having my orchiectomy last Friday. Also Classic Seminoma in three separate nodules ranging from 0.4 to 1.8cm in the right testis. Doctor recommended radiation. My question is even if I do radiation for a month, do I still need to go under surveillance afterwards as if I didn't opt for radiation? If so, then it seems that surveillance is in both pictures and that it just seems that radiation is thrown in as a means to try to decrease the long-term possibility of a recurrence.

[Scott]

Surveillance is required with or without the radiation therapy. One difference is that you don't need abdominal CT scans if you go with radiation, as the likelihood of recurrence in the radiated area is nil.

[rjs]

The biggest difference between pure surveillence and follow-ups after radiation treatment is the frequency of visits and the types of tests run. Make sure you research the treatment protocols on this site for the typical follow-up schedules. I chose the radiation path b/c I did not want to face the uncertainty of the monthly exams and for me the radiation route offered me the most comfort. But with a diagnosis of seminoma the good news is that you have choices and they all offer a very high percentage of success. Study all the choices, ask lots of questions and choose what is best for you.

[tc2006]

Hi cbuysse, have you made a decision meanwhile between radiation and surveillance? I am curious as I am still trying to finda good answer (or criteria for it) myself ...

[Andy Leftgone]

Hi All

not sure if my experience will actually help with any decisions partly because I am in the UK and my treatment was a bit different.

Like you I was diagnosed with pure seminoma <4cm (i think it was about 2) when they suggested surveillance v rad treatment we thought long & hard about it but in the end chose surveillance as it seemed that if I did have a classic recurrence i would have basically the same treatment as I would have had if i didn't choose surveillance albeit a higher dose of rad.

When a year later I did get the recurrence I had 15 days of rad + 1 dose of carbo - I'm not trying to suggest that because I got a recurrence everyone in my situation should immediatley go for radiation treatment, it was just bad luck that i happened to be one of the 30%.. i don't really regret going the surveillance route really it was just like delaying the radiation treatment for a year.. the chemo was a bit of a suprise but one dose was ok

I feel now that I have had the best chance of clearing it without having to endure anything too heavy. One thing, I was told after the CT scan that I had after the treatment that I wouldn't be having anymore scans, but a year later they had changed their surveillance protocol again and I'm now back on 6 monthly CT scans - I haven't really got to the bottom of why, its not anything particular to me, its what they do for all people in my situation now at The Royal Marsden..

Sorry, this probably hasn't helped make the decision any easier, as all have said there is no right or wrong answer..

[huckchef]

i had radiation and they still did ab/pelvis scans on me each time for the first year or so. i think i had a chest/ab/pelvis scan done only once after treatment but several chest x-rays. now i just have chest x-rays from here on out with tumor markers.

[Karen]

My husband's post RT follow ups are every three months for the first 4 years with a physical exam and markers each visit, ab/pelvic CAT every 6 months and chest x-ray once a year.

[tc2006]

Karen, that's good to know. My urologist said no need for CT scans at all after RT, which may be part of the reason why he recommends RT over surveillance, but I thought it would be risky to not do any CT's anymore after RT.

[Scott]

The TCRC information about surveillance after treatment says, "Our surveillance protocols do not call for abdominal CT scans post RPLND or post radiation. Studies have shown that the odds of a recurrence in the retroperitoneum are very small following these therapies, and these odds do not justify the use of a CT scan."

[tc2006]

Andy, I am curious as to why they recommended RT plus Carboplatin for you at the time of your reoccurrence - this combination of RT plus chemo doesn't seem to be a 'standard' protocol for seminoma here in the U.S. Where was your reoccurrence, in the lymph nodes only or (also) in the lungs or any other organs? How large were the masses they found with your reoccurrence ?