20 Treatment Of Stage I Seminoma Testis With Extended Field Adjuvant Radiation U. Mahantshetty, S. Banerjee, S. Kakkar, V. Murthy, G. Bakshi, H.B. Tongaonkar, S. Shrivastava Department of Radiation oncology and Uro-oncology, Tata Memorial Centre, Mumbai, India Correspondence: Umesh Mahantshetty M.D. DNBR, DMRT, Department of Radiation Oncology, Tata Memorial Centre, Dr. E. Borges Marg, Mumbai - 400 012; India. Email- drumeshm@gmail.com Abstract With an aim to analyze and document the outcome of Stage I Seminoma patients we undertook a retrospective analysis of patients treated between January 1990 and December 1998. The treatment charts of patients treated between January 1990 and December 1998 were reviewed. Patient and tumor characteristics, treatment details, relapse rates, late toxicities, or occurrence of second primary was noted. Royal Marsden Staging System was utilized because of its simplicity and wide-use in the above period. Out of 137 patients, 41 (30%) patients did not receive any further treatment, 96 (70%) patients received prophylactic radiotherapy to para-aortic and pelvic nodes. The observation group patients had a median follow-up 20 months, 9 patients had nodal relapse with 7 in retroperitoneal nodes and 2 patients in inguinal nodes. Of these, 7 patients received BEP chemotherapy and 2 patients Chemo- radiation. Four patients had complete remission while remaining 5 patients had partial response. The histopathologies of all the 5 patients with Introduction Seminoma testis is one of the curable cancers with cure rates in early stage disease confned to testis approaching 100%. Post orchidectomy prophylactic radiation to para- aortic and pelvic nodal region, adjuvant chemotherapy or surveillance has been tried with no defnite consensus. Until recently, the majority of patients with Stage I seminoma were treated with prophylactic para-aortic and partial response were reviewed to reconfrm the diagnosis. Patients of prophylactic radiotherapy group had a follow-up of 33 months, 6 patients relapsed, RP nodal disease in 5 patients and distant metastasis in 1 patient. All these patients received BEP chemotherapy. One had complete response and remaining 5 patients had partial response. The group of patients under observation had a signifcantly higher relapse rate and lower disease free compared to the adjuvant radiotherapy group (73.5% vs. 91% at fve years, p value 0.004). Disease specifc survivals for the two groups were however similar (89% vs. 93%) at fve years, p value 0.18). We conclude that Stage I Seminoma patients treated with prophylactic radiation to para- aortic and pelvic region had better outcome. Keywords Seminoma, Observation, Adjuvant Radiotherapy. pelvic lymph nodal irradiation, also known as dogleg or spade shape portal. The results of such treatment are excellent with a long-term survival of approximately 95% (1,2,3,4) . Although chemotherapy is generally considered for more advanced diseases, single agent carboplatin has shown comparable results with radiotherapy in MRC trial (5,6) . Post orchidectomy surveillance has also been explored in a many studies (7,8,9,10) . However, surveillance needs more extensive, prolong follow-up and intense use of resources. Even motivated patients at times eventually become non-compliant (11) . The recurrence rate for patients with seminoma on surveillance is around 16% (8,9,12) . Also, there is no randomized