Radiation-induced tumors in irradiated stage I testicular seminoma: Results of a 25-year follow-up (1968-1993)

Background and Objectives: Testicular seminoma is a very radiosensitive and curable cancer, with survival rates following radiation therapy within the range of 90-98% without apparent severe side effects. However, long-term survival following exposure to moderate-dose radiation therapy can result in radiation-induced tumors. Methods: The incidence of radiation-induced tumors was determined in 81 irradiated stage I testicular seminoma patients treated at the Northern Israel Oncology Center (NIOC) from 1968 through 1993. Results: Three (4%) patients developed second cancers within the high-dose volume. Indeed, those patients received a higher than usual dose to the para- aortic and pelvic regions. One patient, who developed inoperable pancreatic carcinoma, was treated with 'hockey stick' field and mediastinal irradiation, plus, as a result of relapses, multiple cisplatin and VP-16 based regimens. Conclusions: The elimination of causative factors through lower total doses and field size reduction may reduce the, albeit very low, incidence of radiation-induced cancer in cured testicular seminoma.