Clinical characteristics, prognosis and treatment for pelvic cryptorchid seminoma

Purpose: To analyze the clinical characteristics, prognosis, and treatment outcome of pelvic cryptorchid seminoma
(PCS), and to determine whether whole abdominal-pelvic irradiation for Stage I disease is necessary.
Methods and Materials: From 1958 to 1991,60 patients with PCS were treated at the Cancer Hospital of Chinese
Academy of Medical Sciences, Beijing. They presented with a lower abdominal mass and showed a predominance
for the right side. A high proportion of patients with PCS [ 26 of 60 (43% )] had metastatic disease, compared to
20% of those with scrotal seminoma, and there was a tendency toward a higher frequency of pelvic nodal metastases.
There were 34 Stage I, 6 Stage IIA, 11 Stage IIB, 5 Stage III, and 4 Stage IV patients. Of these 60
patients, 56 underwent laparotomy with or without cryptorchiectomy (37 radical orchiectomy, 7 partial orchiectomy,
and 12 biopsy of the primary or cervical node), and 4 cervical node biopsy only. All patients were further
treated with radiotherapy, chemotherapy, or a combination of both. Patients with Stage I and II disease received
radiotherapy, whereas patients with Stage III and IV were treated with chemotherapy.
Results: The overall and disease-free survivals at 5 and 10 years were 92% and 87%, and 88% and 84%,
respectively. The 5- and lo-year survivals were 100% for Stage I, 94% and 87% for Stage II, and 56% and 42%
for Stage III/IV, respectively @ < 0.05). Volume of irradiation, i.e., whole abdominal-pelvic radiotherapy ( 10
patients), versus hockey-stick encompassing paraaortic, ipsilateral iliac nodes and the primary tumor or tumor
bed (17) did not influence outcome in Stage I patients. Five patients relapsed within 2-12 years after treatment,
and four of these patients were successfully salvaged. Four patients developed a second malignant tumor and
died.
Conclusion: Stage I and II PCS can he adequately controlled by radiotherapy regardless of the surgical procedure.
Whole abdominal-pelvic irradiation for Stage I and IIA disease is not required, and fields can be limited to the
paraaortic, ipsilateral iliac nodes and primary tumor or tumor bed. We recommend platinum-based chemotherapy
for Stage IIB-IV PCS. 0 1997 Elsevier Science Inc.