Pure Seminoma

• Seminomas are radiosensitive and adjuvant radiation therapy (RT) to para-aortic and ipsilateral iliac lymph nodes reduces relapse rate to 1-3%
• Treatment should begin once the orchiectomy wound has completely healed and it should be given with a scrotal shield in all patients except in those who underwent bilateral orchiectomy
• Treatment should be performed 5 days/week

Stage I

• Adjuvant RT to include para-aortic nodes may be considered for patients who are not candidates for chemotherapy
  
  • A total dose of 20 Gy administered in 10 fractions of 2.0 Gy each is recommended or as an alternative, a total dose of 25.5 Gy administered in 17 fractions of 1.5 Gy each
  • Careful consideration must be made for patients <40 years due to increased risk of radiation-induced secondary malignancies 

• Radiation of ipsilateral iliac and inguinal lymph nodes including surgical scar from previous surgery may be considered in patients with previous ipsilateral pelvic surgery

Stage II

• Option for stage IIA and stage IIB seminoma, delivered in 2 consecutive phases without break in between and must include RT to para-aortic and ipsilateral iliac lymph nodes
  • Initial phase consists of treatment of modified dog-leg fields with delivery of a total dose of 20 Gy in 10 fractions of 20.0 Gy each or 25.5 Gy in 17 fractions of 1.5 Gy each and 2nd phase or cone down consists of delivery of 1.8-2 Gy fractions with cumulative total dose of 30 Gy for stage IIA and 36 Gy for stage IIB seminoma
• Indicated in select stage II patients with nonbulky retroperitoneal disease (<3 cm)