OBJECTIVE: To evaluate practice patterns of the management of stage I seminoma of testis in Canada and a selected group in the United States.
MATERIALS AND METHODS: Survey among radiation oncologists treating genitourinary (GU) tumors in Canada and the RTOG GU committee members in the United States between January and March 2001.
RESULTS: Response rate was 78% (73/93) in Canada and 67% (24/36) in the United States. Eighty-four percent described their clinical practice as a university affiliated teaching center, and 16% as community-based or private practice. Sixty-two percent, 31% and 7% would manage 1-5, 6-10 and > 11 cases per year respectively. Almost all would perform chest x-ray (99%) and CT scan of abdomen and pelvis (100%) as staging investigation following radical inguinal orchiectomy. Forty percent also arranged CT scan of chest, while only 18% routinely obtained lymphangiogram. Seventy-eight percent offered surveillance as a management option and estimated that 20% (median) of patients would choose surveillance in their practice. Among four management options: (1. surveillance, 2. radiotherapy (RT) to the para-aortic region, 3. RT to the para-arotic and ipsilateral pelvis ('dog-leg'), 4. single-agent chemotherapy), the order of first preference was option 1 (44%), 2 (42%), and 3 (14%) for patients who wish to preserve fertility. When fertility was not a major concern, it was option 2 (43%), 3 (39%), and 1 (17%). The commonest dose-fractionation schedule was 25 Gy/20 fractions (68%). Others included 25 Gy/15 f (15%), and 25.5 Gy/17 f (4%). Forty-five percent chose the para-aortic region, while 53% used the 'dog-leg' as RT volume. Twenty-nine percent reduced RT volume from the 'dog-leg' to the para-aortic region as the result of MRC Phase III study published in 1999.
CONCLUSION: There are significant variations in the practice pattern of the management of stage I seminoma of testis among radiation oncologists in Canada and a selected group in the United States.