The Treatment Modalities in Stage 1 Seminoma; Alterations in Last Five Years

Seminomas are diagnosed generally in early period. Eighty-five percent of the patients were in clinical stage (CS) 1 at the time of diagnosis and occult metastasis rate was 10-15% and systemic relapse rate after retroperitoneal treatment was 1-4%. However, there have been significant alterations in treatment of stage 1 seminomas for 20 years; thus, dog-leg radiotherapy had been recommended as the only choice of adjuvant therapy in 1990s, totally 20 Gy adjuvant radiotherapy to para-aortic (PA) field or hockey stick field and single dose carboplatinium based chemotherapy have been recommended since 2010. Active surveillance has become popular after the relation between radiotherapy and platinum based chemotherapy with cardiovascular toxicity and seconder malignancy was proven and long term results of surveillance were reported. Achieving the cure rates of % 100 in CS 1 seminoma patients with all kind of therapy modalities, adjuvant radiotherapy, chemotherapy or active surveillance, indicate that all kinds of therapies are appropriate. However, the relapse rate of 15-20% of the disease in the patients under surveillance without any treatment indicates the over-treatment risk of 80-85%. In conclusion, the identified side effects of the radiotherapy and chemotherapy, the report of successfully treatment of the disease even in the relapse under active surveillance caries the surveillance as the first choice in guidelines however it is seem that the best approach is to give the decision with the patient after detailed information by taking into consideration of the patients expectations.