Abstract：
OBJECTIVE: Novel techniques and advances in radiation therapy (RT) have been explored to treat testicular seminoma, a highly radiosensitive and curable histology. We evaluated the historical and current indications for radiation therapy (RT) in testicular seminoma.
METHODS: A narrative literature review was performed. Studies of RT for testicular seminoma were included. Additionally, recent trials testing the use of combination or surgical therapies for clinical stage (CS) II were included. Search parameters included radiation therapy, testicular seminoma, surgery, and chemoradiation. Parameters and outcomes assessed were progression-free survival (PFS), overall survival (OS), acute toxicities, long-term sequelae, and rates of secondary malignancies.
RESULTS: Practice defining and changing studies in the use or omission of radiation therapy for testicular seminoma were identified along with resultant changes in National Comprehensive Cancer Network (NCCN) and European guidelines. Recent trials in combined chemoradiation and upfront surgical approaches to CS II disease were reviewed.
CONCLUSIONS: RT has historically been used as adjuvant treatment for CS I disease and is highly effective at treating CS II (A/B) testicular seminoma. The drive to maintain therapeutic efficacy and reduce acute and long-term side effects, namely secondary malignancies, is being tested using new radiation technologies, combined modality therapy in the form of chemoradiation and with upfront surgical approaches. Also, as guidelines now \"strongly prefer\" surveillance instead of adjuvant RT for CS I disease, the current CS II population comprises patients presenting with CS II disease (\"de novo\") and those who present with CSII after relapsing post orchiectomy for CS I (\"relapsed\"). Emerging evidence suggests that these two groups have different outcomes with respect to RT and chemoradiation. Consequently, future trials may need to sub-stratify according to these groups.
METHODS: A narrative literature review was performed. Studies of RT for testicular seminoma were included. Additionally, recent trials testing the use of combination or surgical therapies for clinical stage (CS) II were included. Search parameters included radiation therapy, testicular seminoma, surgery, and chemoradiation. Parameters and outcomes assessed were progression-free survival (PFS), overall survival (OS), acute toxicities, long-term sequelae, and rates of secondary malignancies.
RESULTS: Practice defining and changing studies in the use or omission of radiation therapy for testicular seminoma were identified along with resultant changes in National Comprehensive Cancer Network (NCCN) and European guidelines. Recent trials in combined chemoradiation and upfront surgical approaches to CS II disease were reviewed.
CONCLUSIONS: RT has historically been used as adjuvant treatment for CS I disease and is highly effective at treating CS II (A/B) testicular seminoma. The drive to maintain therapeutic efficacy and reduce acute and long-term side effects, namely secondary malignancies, is being tested using new radiation technologies, combined modality therapy in the form of chemoradiation and with upfront surgical approaches. Also, as guidelines now \"strongly prefer\" surveillance instead of adjuvant RT for CS I disease, the current CS II population comprises patients presenting with CS II disease (\"de novo\") and those who present with CSII after relapsing post orchiectomy for CS I (\"relapsed\"). Emerging evidence suggests that these two groups have different outcomes with respect to RT and chemoradiation. Consequently, future trials may need to sub-stratify according to these groups.
摘要：
目的：已经探索了放射治疗（RT）的新技术和进展，以治疗睾丸精原细胞瘤。一种对辐射高度敏感和可治愈的组织学。我们评估了睾丸精原细胞瘤放射治疗（RT）的历史和当前适应症。
方法：进行叙述性文献综述。包括睾丸精原细胞瘤的RT研究。此外,纳入了最近的试验,试验了临床分期(CS)II期联合治疗或手术治疗的应用.搜索参数包括放射治疗，睾丸精原细胞瘤，手术,和化学放射。评估的参数和结果是无进展生存期（PFS），总生存期（OS），急性毒性，长期后遗症，和继发性恶性肿瘤的发病率。
结果：确定了睾丸精原细胞瘤使用或省略放射治疗的实践定义和改变研究，以及国家综合癌症网络（NCCN）和欧洲指南的结果变化。回顾了最近在联合放化疗和CSII疾病的前期手术方法方面的试验。
结论：RT历来被用作CSI疾病的辅助治疗，在治疗CSII（A/B）睾丸精原细胞瘤方面非常有效。保持治疗效果并减少急性和长期副作用的动力，即继发性恶性肿瘤，正在使用新的辐射技术进行测试，以放化疗和前期手术方式进行综合治疗。此外，作为指南，现在“强烈倾向于”监测，而不是CSI疾病的辅助RT，当前的CSII人群包括出现CSII疾病的患者(“从头”)和在CSI的睾丸切除术后复发后出现CSII的患者(“复发”).新出现的证据表明，这两组在RT和放化疗方面具有不同的结果。因此,未来的试验可能需要根据这些组进行亚分层.
方法：进行叙述性文献综述。包括睾丸精原细胞瘤的RT研究。此外,纳入了最近的试验,试验了临床分期(CS)II期联合治疗或手术治疗的应用.搜索参数包括放射治疗，睾丸精原细胞瘤，手术,和化学放射。评估的参数和结果是无进展生存期（PFS），总生存期（OS），急性毒性，长期后遗症，和继发性恶性肿瘤的发病率。
结果：确定了睾丸精原细胞瘤使用或省略放射治疗的实践定义和改变研究，以及国家综合癌症网络（NCCN）和欧洲指南的结果变化。回顾了最近在联合放化疗和CSII疾病的前期手术方法方面的试验。
结论：RT历来被用作CSI疾病的辅助治疗，在治疗CSII（A/B）睾丸精原细胞瘤方面非常有效。保持治疗效果并减少急性和长期副作用的动力，即继发性恶性肿瘤，正在使用新的辐射技术进行测试，以放化疗和前期手术方式进行综合治疗。此外，作为指南，现在“强烈倾向于”监测，而不是CSI疾病的辅助RT，当前的CSII人群包括出现CSII疾病的患者(“从头”)和在CSI的睾丸切除术后复发后出现CSII的患者(“复发”).新出现的证据表明，这两组在RT和放化疗方面具有不同的结果。因此,未来的试验可能需要根据这些组进行亚分层.
