Ⅰ期睾丸精原细胞瘤放射治疗结果和远期并发症

RADIOTHERAPY FOR STAGE Ⅰ TESTICULAR SEMINOMA:TREATMENT RESULTS AND LONG-TERM MORBIDITY

195 8年至 1 990年 1 2月 ,收治 2 0 0例Ⅰ期睾丸单纯精原细胞瘤。所有病人在睾丸切除术后行膈下放疗。全组 5、1 0和 2 0年生存率分别为 98 9%、98 2 %、和 96 8%。 7例治疗后复发 ,多数远处转移 ,腹腔复发和照射剂量低有关。远期并发症中 ,3%的患者合并十二指肠球部溃疡和胃粘膜脱垂 ,下肢水肿和放射性膀胱炎少见。 9%的病人发生第二原发肿瘤 ,其中 4 5 %发生在 1 0年后。无论是否经阴囊手术或肿瘤侵犯白膜 ,均不必行阴囊和腹股沟照射。我们认为 ,腹主动脉旁和同侧髂血管淋巴引流区预防照射仍然是安全有效的 ,并发症极少 ,照射剂量以DT2 5Gy为宜。

Two hundred patients with stage I testicular seminoma were treated with orchiectomy and infra-diaphragmatic radiotherapy from 1958 to December 1990. The survival rate was 98.9%,98.2% and 96.8% at 5,10 and 20 years,respectively. Seven patients relapsed and four died of progressive. Two of them developed infra-diaphragmatic recurrence, which were related to the low dose (DT 6 Gy and 13 Gy,respectively). Eighteen second malignancies were observed, four tumors in the controlateral testes. 3% of patients had complication of peptic ulceration during 10 years. The results indicated that low-dose infra-diaphragmatic adjuvant radiotherapy still is simple, effective, and nontoxic in the treatment of stage I testis seminoma.