If you've been diagnosed with seminoma, a common form of testicular cancer, it's very likely you'll make a full recovery. This type of cancer, which originates in germ cells in the testicles (also called pure, or classical, seminoma) usually responds well to radiation therapy. Coupled with surgery and chemotherapy, this has helped make survival rates for patients with Stages I and II seminoma nearly 100%.
Part of that success is derived from Yale Medicine’s commitment to advancing the field, says James Yu, MD, MHS, director of Yale Medicine's Prostate & Genitourinary Radiotherapy Program. “We're always looking for even the smallest improvements.”
Who is eligible for radiation therapy for testicular cancer?
In general, patients with early-stage seminoma, who have undergone proper surgical removal of their testicular cancer (through an operation called a radical orchiectomy), may be good candidates for radiation therapy.
Seminomas are sensitive to radiation, so the treatment is usually successful. In contrast, experience and research have shown that non-seminoma cancers respond better to chemotherapy than to radiation; they’re just not sensitive enough to the radiation to be reliably eradicated.
How is radiation therapy used with other treatments?
Our Tumor Board, which meets monthly, allows doctors and experts to approach all treatment in a multidisciplinary way. Specialists join together, sharing the best opinions for both primary treatment and follow-up options.
Depending on the patient’s age and the progress of the cancer, treatment will likely include surgery; it may also include chemotherapy, if the cancer has spread beyond our ability to radiate or if chemotherapy is the more effective treatment.
How does radiation therapy for testicular cancer work?
Most people are referred to their radiation oncologist by their urologist, after surgery. The first step is an in-depth conversation with the doctor to discuss treatment risks and benefits as well as fertility. While standard surgical treatment of testicular cancer is the removal of the involved testicle, both radiation and chemotherapy can also reduce fertility. "We encourage young men who want to have children to cryopreserve their sperm prior to treatment," says Dr. Yu.
Once you and team decide to go forward, a computerized tomography (CT) scan of your body helps create a three-dimensional map of your anatomy, which allows your doctors to map the course of radiation.
During the next week or two, physicists, a dosimetrist (radiation design specialist) and radiation therapists help design the plan. The physicists and dosimetrists in particular, are instrumental in helping calibrate how the radiation will move through the three-dimensional space of the body — the tissue, muscle and bone — to deliver a high dose to the targeted area. They also build a custom body mold that hold you in the right position.
Once the whole plan has been approved and put through an exhaustive quality assurance process, you return for a dry run. You'll be set up in the body holder you’ll lie in during the treatment, and x-rays will be taken to confirm that the position is correct. If the plan checks out – meaning the actual x-ray lines up with the expected one – the radiation treatment begins soon after that. The treatment itself usually only lasts a few minutes: All you have to do at that point is lie still. The number of treatments ranges from about 10 to 18.
How successful is treatment?
For Stage I and II seminomas, success – total eradication of the tumor – approaches 100%t at five years. That’s part of the reason Yale Medicine is so focused on customizing treatment to patients: Since survivorship is so strong, we want to optimize quality of life after treatment.
After treatment, your team continues to see you and perform periodic blood tests and CT scans, and sometimes X-rays of the chest, to track any tumor recurrence. In stage III seminomas, the cancer has spread too far around the body for radiation to be a good treatment option.
What are the potential side effects?
Short-term, a patient may be tired and nauseated. Doctors often prescribe anti-nausea medicine to take before treatment starts, to minimize this effect.
The Department of Therapeutic Radiology also has a nutritionist and a social worker available; they can meet with you to figure out how to keep you comfortable after treatment.
Diarrhea is another common complaint; to minimize this, we recommend over-the counter medication.
Following radiation, there is sometimes a drop in blood count, which happens when radiation irradiates a fair amount of nearby bone marrow. You may experience low blood count as well as tiredness and susceptibility to infection.
Are there any long-term risks?
Long-term, high doses of radiation are associated with a greater risk of malignancies 10 to 20 years down the road.
Because of that, we tend to encourage younger men to consider chemotherapy or observation before any radiation.
Still, the pros and cons are not so clear-cut: Chemotherapy also carries a risk of secondary tumors and has a slightly higher rate of infertility, while the population who has testicular cancer is also at a higher risk than the general population for developing other tumors. This complexity is why our team works together closely to weigh the pros and cons for each patient.
How is Yale Medicine's approach unique?
Yale Medicine’s multidisciplinary team fosters a customized approach to every patient’s condition, paving the way for coordinated treatment. Yale Medicine also has the largest physics staff in the state in clinical radiation, which means that every plan developed is double- and triple-checked with rigorous quality assurance.
Additionally, Yale Medicine oncologists and urologists are all plugged in to the latest news and regularly discuss breakthroughs with one another and with the radiation oncologists, fostering a community of engaged and forward-thinking doctors.
This open-mindedness has allowed us to make continuous improvements in equipment, speed and targeting that help us move our field forward and improve patient outcomes. For example, radiation dose is calculated by modeling how millions of photons move through a person’s body. “A decade ago, it took a day to do this calculation. Now, it takes 10 minutes,” says Dr. Yu. “Because we have that speed, we can create better and better treatment plans, whereas in the past, we might not have had the time to try again.”
Also, Yale Cancer Center's Cancer Survivorship Program, led by Tara Sanft, MD, provides care to patients beyond their cancer treatment – which is particularly important for testicular cancer, where we expect patients to live cancer-free for many years after their treatment.
We have the largest team of radiation specialists in the state.