A new protocol for seminoma is now available. It replaces SWENOTECA VII from October 1, 2014.
The major changes in the guideline are:
Patients with tumour size 4 cm or less and without invasion of the rete testis are recommended surveillance.
Patients with tumour size more than 4 cm or invasion of the rete testis are recommended adjuvant carboplatin. Surveillance may be an option to those patients not wanting adjuvant treatment.
Stage II A
Chemotherapy in the form of BEP x 3 or radiotherapy 2 Gy x 15 to 30 Gy to the para-aortic, the ipsilateral common iliac- and the external iliac lymph nodes may be used as primary treatment
Stage II B-IV
The standard treatment is BEP x 3. In patients with contraindication to bleomycin EP x 4 should be used.
Radiotherapy for cancer in situ (CIS) in the contralateral testicle:
Many SWENOTECA centers have prescribed an average target dose of 16 Gy, 2 Gy x 8. And therefore a part of the testicle has got a dose < 16 Gy. There have been relapses after irradiation for CIS. Our new recommendation is therefore: The target dose should be average 18 Gy, 2 Gy x 9, in order to get a minimum dose of 17 Gy in the testicle.