Tweede primaire maligniteiten bij seminoma testis stadium I, behandeld met adjuvante radiothérapie

The Dutch guideline for testicular germ cell tumours advises adjuvant radiotherapy to the para-aortic lymph nodes for stage I testicular seminoma (SITS). Radiotherapy has been associated with increased incidence of malignancies among cancer survivors. There is evidence that both active surveillance as single agent carboplatin chemotherapy are safe treatment modalities for SITS. We investegated, with an unique study design, the risk of developing a second primary malignancy (SPM) for patients with SITS, treated with adjuvant radiotherapy. Data were collected by the Comprehensive Cancer Center Middle Netherlands (CCCMN). Overall 163 patients with stage I testicular cancer, treated with adjuvant radiotherapy between 1985 and 2004 in the region Utrecht, were compared to 211 patients with stage I testicular cancer on an active surveillance policy. Fourteen patients (8.6%) treated with adjuvant radiotherapy developed a SPM, compared to four patients (1.9%) in the active surveillancecohort. This resulted in a hazard-ratio of J 2-91 (95%-CI 0.95-8.90; ρ=0.062) for patients treated with adjuvant radiotherapy. Although not significant, there seems to be a trend that patients treated with adjuvant radiotherapy have an increased risk of developing a SPM. A larger study population is needed to confirm this.