Does radiotherapy still have a place in the treatment of stage I seminoma?

For the last 60 years, radiotherapy delivering 30 Gy to homolateral iliac and paraaortic lymph nodes has been the standard treatment for clinical stage I seminoma. Adjuvant radiotherapy after orchidectomy is associated with a potential carcinogenic risk. The risk depends on the irradiation field and the dose delivered. The risk appears to be low with low-dose (20 Gy) irradiation techniques. However, the late effects of radiotherapy have led to the search for alternative adjuvant approaches, including surveillance and carboplatin chemotherapy. Finally, experience with surveillance strategies in patients with stage I seminoma have allowed a meta-analysis of predictive factors for relapse, distinguishing patients requiring post-orchidectomy adjuvant therapy from those who can be easily followed by a surveillance strategy. Although this attitude can constitute a reasonable alternative for low-risk patients and appears to be acceptable for patients who find the carcinogenic risk of radiotherapy unacceptable, its disadvantage is the need for long-term surveillance.