Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

Seventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months).At the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy.Our results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum are effective measures in preventing local failure.Testicular cancer is the most common malignancy in men 20 to 40 years of age [1]. More than half of patients with testicular cancer are found to harbor a seminoma [2]. Over the past years, there has been a continuously increasing incidence of testicular seminoma in the Western world and Japan [3,4]. In the United States, 8480 new cases and 350 deaths were expected in 2010 [5]. Seventy to eighty percent of seminoma patients present with stage I disease [2]. High inguinal orchiectomy is the standard initial treatment [1]. Due to the lack of comparative randomized trials, the choice of the most a