Radiation Therapy More Effective Treating Early Stage 2 Testicular Cancer

Currently, no consensus exists about whether chemotherapy or radiation should be used to treat early stage 2 testicular cancer.

A recent study suggests that radiation therapy is a more effective treatment for patients with early stage 2 testicular cancer.

In the study, published in Clinical Oncology, researchers evaluated 2437 patients with stage 2a testicular seminoma were either treated with radiation therapy or chemotherapy between 1998 and 2012.

Of the 960 patients with 2a disease, 78% received radiation therapy and 22% received chemotherapy. Of the 812 patients with 2b disease, 54% received radiation therapy and 46% received chemotherapy.

Researchers also examined 665 patients with 2c disease, with 4% receiving radiation therapy and 96% receiving chemotherapy. Researchers found that 99% of patients treated with radiation therapy were alive after 5 years compared with 93% of patients treated with chemotherapy.

Patients with 2b disease treated with radiation therapy had a 95% survival rate after 5 years compared with the 92% of patients treated with chemotherapy.

"For stage 2c patients, there is clear consensus that multi-agent chemotherapy is the preferred treatment as the risk of distant progression is high, whereas for stage 2a-b there is no such consensus as to the optimal treatment and practice patterns vary significantly,” said Scott Glaser, MD, resident physician at the University of Pittsburgh Cancer Institute. “In our series, 96% of stage 2c patients received multi-agent chemotherapy, which also severely limits meaningful comparison to other treatments.”

Researchers believe that their results support the recommendation that patients with stage 2a should be treated with radiation therapy.

"We view stage 2b disease as a spectrum where smaller volume disease patients (i.e. those with a 2-3 cm tumor in a single lymph node) may act more like 2a disease and attain the greatest benefit from radiation therapy, whereas patients with a larger volume of disease (i.e. 4-5 cm tumor or that has spread to multiple lymph nodes) may act more like 2c disease and attain the greatest benefit from chemotherapy,” Dr Glaser concluded. "Our results demonstrate the need for a collaborative group effort to open a randomized trial for stage 2a-b testicular seminoma patients examining the role of radiation therapy and chemotherapy."