Stage II testicular seminoma: evolution of radiotherapeutic practice in the United States.

We studied the evolution of treatment philosophy for testicular seminoma, by means of a questionnaire mailed to radiation oncologists practising in the United States. Of the 600 respondents 65% indicated a change in treatment policy since 1982. In patients with stage IIA disease the mediastinum is no longer treated by 62% of physicians, whereas 38% omit such treatment in Stage IIB patients. A trend towards the use of lower doses of radiation in areas treated was also noted. Omission of mediastinal irradiation in some stage II patients may be associated with an increased risk of failure in this site. Patients who do not receive treatment to the mediastinum must be carefully followed for recurrent tumour.