The response of lymph node metastases of testicular teratoma to radiation therapy.

The response to radiation therapy of lymph nodes metastases from testicular teratomas has been examined in 117 Stage I and II patients treated between 1962 and 1972. It is not possible to obtain reliable estimates of the percentage Stage I patients with occult retroperitoneal node metastases; however, available evidence suggests that spread of tumour to the lymph nodes has occurred in a proportion (possibly as many as 50%) of patients in this category. Radiation therapy is an effective method of achieving tumour eradication and overall survival results in this group are good (84%). In a smaller group of Stage II patients with unequivocal lymphographic evidence of nodal spread, the effectiveness of irradiation is dependent upon tumour volume. In those patients with metastases 2 centimetres or less in diameter, the results of treatment are similar to Stage I and we have designated this group Stage IIa. In those patients with larger volume metastases, two thirds have developed abdominal node relapse, in most cases associated with distant spread. We have designated this group Stage IIb. The implications of these observations for overall management are discussed.