Testicular Tumors (Testicular Malignancies): Radiotherapy

Tumor type and radiation sensitivity:

  • Seminoma is highly radiosensitive.
  • Non-seminoma is only moderately sensitive to radiation.

Radiation therapy measures:

  • “For eradication of GCNIS (Germ cell neoplasia in situ; germ cell tumor in situ) after organ-preserving therapy in single testis, adjuvant irradiation of the affected testis with 18-20 Gy should be performed. Since the appearance of a manifest germ cell tumor (GCNIS) may take several years, regular sonographic monitoring should be discussed if the patient wishes to have children” [S3 Guideline]Note: With wait-and-see observation of GCNIS, invasive GCNIS develops in 50% of cases within five years [S3 Guideline].
  • Metastatic germ cell tumors of the testis: seminoma at stage cSIIA: 30 Gy total dose and at stage cSIIB with 36 Gy total dose.
  • Paraaortic (“around the aorta/aorta”) irradiation with 20 Gy:
    • Stage I (tumor confined to the testis):
      • Radiation therapy at this stage has come under heavy criticism. One study showed that after 18 years, 14% of patients are likely to have second tumors (including pancreatic, gastric, and urinary bladder tumors).S3 guideline: for CS-I seminoma, generally surveillance (monitoring); if there is a reason to deviate from the recommendation of surveillance, the option is: 1-2 x carboplatin or radiatio (radiotherapy).
    • Seminoma: stage IIA (retroperitoneal lymph node metastasis; lymph nodes < 2 cm).
    • Seminoma: stage IIB (retroperitoneal lymph node metastasis; lymph nodes 2-5 cm).
    • Local recurrence (recurrence of disease) of a seminoma.
    • Evidence of testicular intraepithelial neoplasia (TIN) on biopsy of the contralateral (opposite) testis.