Radiation therapy: a primary treatment modality for seminoma.

It would appear that: (1) Seminomas are radiosensitive neoplasms. (2) Patients with stage I seminoma, including anaplastic seminoma, should receive radiation therapy to the para-aortic and ipsilateral pelvic and inguinal nodes. (3) Most patients with stage II seminoma (including anaplastic seminoma) with negative human chorionic gonadotropin results also respond well to radiation therapy that includes the mediastinum and appropriate supraclavicular area. However, surgery and chemotherapy are indicated in patients with bulky stage II disease and in those patients with persistent elevation of postorchiectomy human chorionic gonadotropin. (4) Patients with stage III seminoma should receive chemotherapy initially. (5) Serum tumor markers may be a major diagnostic and staging modality in seminoma, as patients with an elevated alpha-fetoprotein (AFP), before or after orchiectomy, demonstrate evidence of a nonseminomatous germ cell neoplasm and should be treated accordingly despite the lack of histologic confirmation in the testicular tissue. Approximately 10 per cent of patients with seminoma will have an elevated level of human chorionic gonadotropin. The clinical significance of this finding requires further study.