Classically for stage 1 seminoma – dog-leg with retroperitoneal nodes + ipsilateral pelvic nodes.
Recurrence after radiation is out of field – commonly thorax and supraclavicular fossa
Radiation 20 – 24 Gy.
Also used for GCNIS.
Acute generalised side effects:
- Nausea and vomiting
- Diarrhoea
- Haematologic toxicity
Late GI side effects:
- Chronic dyspepsia
- Peptic ulcer disease
Scatter to contra-lateral testis can be significant despite shielding -> increased oligospermia rates.
Late cardiac risk and secondary malignancy are worrisome given length of survival after treatment.
Possible actuarial risk of developing secondary malignancy up to 18 % at 25 years
- Leukaemia (both XRT and chemo)
- Upper GI, bladder, sarcoma and possibly pancreatic cancers linked to XRT
- NB also radiation risk due to recurrent CT scans may be a factor
The cardiac risk of radiation is less clear although seems to definitely be a factor for those with mediastinal irradiation. Some retrospective cohort analyses has shown an increased cardiac-specific risk even for those radiated below the diaphragm.