This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chan, R. Search for Related Content PubMed PubMed Citation Articles by Chan, R. Related Articles Related Reply Social Bookmarking                            What's this?

Randomized Trial of 30 Versus 20 Gy in the Adjuvant Treatment of Stage I Testicular Seminoma: A Report on Medical Research Council Trial TE18, European Organisation for Research and Treatment of Cancer Trial 30942 (ISRCTN18525328)

Department of Radiation Oncology, Christus Schumpert Cancer Treatment Center, Shreveport, LA

To the Editor:

I would like to congratulate the efforts of Jones et al¹ for their article published in the February 20 issue of the Journal of Clinical Oncology, in which they defined the appropriate radiation dose in the adjuvant treatment of stage I seminoma. It was a well done randomized trial, which tried to answer several important questions in the treatment of seminoma. Nearly 90% of the patients in the study received para-aortic strip only irradiation (PAS), without treatment to the pelvis. With reference to Table 3 of their article, I have several questions and comments.

The recurrence pattern is very interesting to look at, even though it is for a small number, which has its limitations. Six (60%) of the 10 recurrences in the 30-Gy group were in the pelvic nodes, whereas three (27%) of 11 in the 20-Gy group were in the pelvic nodes. The locations of the pelvic nodes recurrences were not mentioned, so we could not see whether these recurrences could potentially have been prevented by the use of the dogleg (DL) field. If we accept the conclusions of the study, ie, 20 Gy is as effective as 30 Gy, and then we retrospectively look from the treatment-field perspective, only 1/5 of the recurrences in the DL-treated patients was in the pelvic nodes, whereas for eight of 16 patients in the PAS-treated group the recurrences were in the pelvis. The difference in the abdominal recurrences in both groups is not as dramatic (DL, one of five; PAS, three of 16). That is as far as what can be dissected out from these data on such a small number of events. However, the data suggest (1) 20 Gy versus 30 Gy is about the same in preventing para-aortic recurrences; (2) the addition of pelvic radiation may reduce pelvic node recurrences (if these recurrences were in the potential DL fields). If that is the case, the patients in the 30-Gy group may actually have a lower overall recurrence rate (four nonpelvic-node recurrences) compared with the 20-Gy group (eight nonpelvic node recurrences), which in turn may change the overall results in the trial. This certainly opens up another can of worms in term of considering the need of using the DL field again for the treatment of stage I seminoma for doses like 20 Gy. I hope the authors can address my concerns.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCE

1. Jones WG, Fossa SD, Mead GM, et al: Randomized trial of 30 versus 20 Gy in the adjuvant treatment of stage I testicular seminoma: A report on Medical Research Council Trial TE18, European Organisation for Research and Treatment of Cancer Trial 30942 (ISRCTN18525328). J Clin Oncol 23:1200-1208, 2005[Abstract/Free Full Text]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Reply

• In Reply:
  S.P. Stenning, W.G. Jones, and S.D. Fossa
  JCO 2005 23: 6806-6807 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Chan, R. Search for Related Content PubMed PubMed Citation Articles by Chan, R. Related Articles Related Reply Social Bookmarking                            What's this?