Post-Orchiectomy Radiotherapy as an Effective and Safe Adjuvant Therapy for Patients of Stage Ⅰ Testicular Seminoma

由於第一期睪丸精原細胞癌的治癒率已接近百分之百，如何減少治療造成的晚期副作用，成爲近年來研究精原細胞癌者的一個注意焦點。加以有文獻報導此期病人施以睪丸切除術後，僅有3-20%日後會復發，因此也就有人質疑睪丸切除術後是否仍有必要給予例行的手術後放射治療。本文分析三軍總醫院放射腫瘤部於民國63到80年間，以放射線照射22例第一期與9例第二期睪丸切除術後之精原細胞癌病人的經驗。第一期病人的追蹤中期爲10年11個月，第二期爲10年3個月。累積五與十年存活率在第一期均爲100%，第二期均爲89%。如果將死於其它疾病的資料不計，則兩期病人之五年與十年存活率均爲100%。不孕病人佔53.3%，是最常見與唯一有意義的晚期併發症，其原因可能是疾病本身表現、民國72年以前病人接受陰囊照射時的散射劑量、或病人自願不孕。本文認爲，第一期睪丸精原細胞癌病患在睪丸切除術後，接受橫膈下區域2500cGy的放射治療，不僅有效而且安全。在目前由於此類病患並無可靠血清腫瘤標記可供監視，加以長期密切追蹤實際上窒礙難行，不宜貿然採用不給手術後放射治療的監視政策，仍應給予例行之手術後放射治療。

關鍵字

睪丸腫瘤；精原細胞癌；睪丸放射治療學

並列摘要

As the cure rate for patients of stage Ⅰ testicular seminoma approaches 100%, treatment-related late effect has become the center of concern. A routine use of post-orchiectomy radiotherapy has been questioned when a low relapse rate after orchiectomy alone becomes evident. We report our experience in treating 22 stage I and 9 stage Ⅱ patients with post-operative radiotherapy during the period between 1974 and 1991. The median follow-up period was 10 years and 11 months for stage Ⅰ, and 10 years and 3 months for stage Ⅱ patients. The actuarial 5- and 10-year survival rates were both 100% for stage Ⅰ and both 89% for stage Ⅱ patients, respectively. They were all 100% if death due to intercurrent disease was corrected. No radiation-induced late complication was noted except infertility which was found in 53.3% patients married for a minimum of 2 years. It was considered either due to the disease itself or scattered radiations from the scrotal irradiation given to the patients before 1983, as well as the possibility of voluntary infertility. We conclude that post-orchiectomy radiotherapy using 2500 cGy to the infradiaphragmatic area is an effective and safe modality and may be applied to all patients of stage Ⅰ testicular seminoma when a surveillance policy is practically difficult.

並列關鍵字

Testis, neoplasm ； seminoma ； testis, therapeutic radiology

國際替代計量

Post-Orchiectomy Radiotherapy as an Effective and Safe Adjuvant Therapy for Patients of Stage Ⅰ Testicular Seminoma

全文下載

主題瀏覽