SEMINOMA OF THE TESTIS - LONG-TERM BENEFICIAL AND DELETERIOUS RESULTS OF RADIATION
SEMINOMA OF THE TESTIS - LONG-TERM BENEFICIAL AND DELETERIOUS RESULTS OF RADIATION
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DOI：
10.1016/0360-3016(92)90475-w
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发表时间：
1992-01-01
影响因子：
7
通讯作者：
OWEN, J
中科院分区：
文献类型：
--
作者：
HANKS, GE;PETERS, T;OWEN, J
目的。在1973年和1974年美国对精原细胞瘤进行放射治疗的全国性调查中，对387名患者的随访时间延长到了15年以上，以评估治疗的长期好处和问题。15年生存率I期83%，II期68%；15年无复发生存率I期93%，II期96%；NED 15年生存率I期80%，II期68%；因癌特异性死亡I期98%，II期15年97%。15年后，二次恶性肿瘤的发生率为8%，观察到14名患者，而预期为4.2(p<；.001)。这第二种癌症的死亡人数也有所增加，观察到的死亡人数为7人，预期为2人(P<；.01)。23名患者发生非癌症合并疾病死亡，而预期死亡人数为7.5人(p<；.01)。最常见的原因是心源性死亡，10例患者中有10例，而预期为4.4例(p<；0.05)，10例患者中有8例接受了纵隔放射治疗。另有两名患者在纵隔放疗后死于肺纤维化。纵隔放射与所有并存疾病和心肺死亡相关(P<；0.05)，但与第二种恶性肿瘤无关。除1例外，所有患者在治疗时年龄均大于或等于40岁，年龄范围为32-58岁，平均死亡时间为9.8年。对精原细胞瘤未来治疗的建议包括：减少I期患者治疗时的照射体积，完全消除IIA期精原细胞瘤患者的纵隔放射，以及IIB期精原细胞瘤患者的化疗。放疗剂量I期不宜超过30GY，IIA期不宜超过35Gy.
Purpose. The followup of 387 patients in a USA national survey of seminoma treated with radiation in 1973 and 1974 has been extended beyond 15 years to assess the long-term benefits and problems resulting from treatment.Results. Survival at 15 years is 83% for Stage I, 68% for Stage II; freedom from recurrence at 15 years is 93% for Stage I, 96% for Stage II; NED survival at 15 years is 80% for Stage I, 68% for Stage II; cause specific freedom from cancer death is 98% for Stage I and 97% for Stage II at 15 years. Second malignancy rates were 8% at 15 years, and observed in 14 patients versus 4.2 expected (p < .001). Deaths due to these second cancers were also increased with seven observed versus two expected (p < .01). Non-cancer intercurrent disease death occurred in 23 patients versus 7.5 expected (p < .01). The most frequent cause was cardiac death which appeared in 10 patients versus 4.4 expected (p < .05) and 8 of the 10 patients received mediastinal radiation. Two additional patients died of pulmonary fibrosis after mediastinal radiation. Mediastinal radiation correlated with all intercurrent disease and cardio-pulmonary deaths (p < .05), but not with second malignancies. With the exception of one, all patients experiencing cardiac death after mediastinal irradiation were 40 years or older at the time of treatment, with a range of 32-58 years and a mean interval to death of 9.8 years.Conclusions. Recommendations for the future management of seminoma include: reducing the irradiated volume in the treatment of Stage I patients, completely eliminating mediastinal radiation in the treatment of patients with Stage IIA seminoma and treating patients with Stage IIB seminoma with chemotherapy. Radiation dose should not exceed 30 Gy for Stage I or 35 Gy for Stage IIA.