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Radiation Treatment For Testicular Cancer

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Radiation Treatment For Testicular Cancer

Postby Eadgar » Tue Apr 26, 2016 3:00 am

Dr. Seigle, Thank you in advance for making yourself available in this forum. My question involves a Stage 1 seminoma that has thus far been treated w/ an inguinal orchiectomy. The pelvic/abd CT was clear and we planned to proceed w/ radiation,  however a malpositioned and centrally located kidney has been revealed on CT. Due to the position of the kidney, it will now be partially in the radiaton field and at risk for damage. I know the statistics and what watchful waiting involves if I choose to not proceed w/ radiation due to concern for my renal function. BUN/ Creat/ GFR are normal at 36 years old. My main question is what are the risks for damaging my kidney(I realize the vast majority of people w/ one kidney do just fine) Can I get your expert consultation/opinion on this matter for someone who has a background as a nurse practitioner in the critical care setting. Are there any case studies, research on this? What have you seen or what can you tell me to help make an informed decision?

Many thanks,

Shannon
Eadgar
 
Posts: 63
Joined: Thu Jan 30, 2014 8:25 am

Radiation Treatment For Testicular Cancer

Postby Akeno » Tue Apr 26, 2016 10:53 am

Dear Shannon,

How many kidneys do you have?  Some people have a single centrally located kidney, often called a horseshoe kidney depending on its shape; is this so in your case?  Or do you have two separate kidneys with one more centrally located than is typical?  

The radiation dose used for treatment of seminoma is high enough to damage the portion of the kidney that is in the treatment field.  Therefore, if an adequate portion of the kidney(s) cannot be spared, one would not want to treat with radiation.  Yes, you can live perfectly normally with only one kidney.

Orchiectomy alone is a reasonable approach if your doctors feel that your renal function is at risk.  You would have to have regular CT scans(several times a year initially) but could be treated later if there is any indication that the cancer has recurred.  Only 20-25% of people with Stage I seminoma treated with orchiectomy alone will have a relapse later on; most relapses are readily treated   Thus, you have a 75% chance(approximately) of never needing any further treatment if you don't have radiation.  

Finally, there is a third option:  some people have tried a single course of carboplatin chemotherapy.  Its chemotherapy cousin, cisplatin, is known for its kidney toxicity.  Carboplatin is a gentler drug with fewer adverse effects than cisplatin.  From what is known so far, the results of a single treatment with carboplatin are as good as any other therapy(though since it is a new approach, patients who have been treated this way have not been followed for many years as they have been with radiation).  

You should be seeing and speaking with someone who has a lot of expertise in the treatment of seminoma.  Probably the greatest expert on this would be Gillian Thomas(Canadian).  Perhaps she would be willing to discuss the situation with you.  You would have to look up her contact information.

Sincerely,

J. Seigle, MD
Akeno
 
Posts: 56
Joined: Wed Feb 26, 2014 8:12 am

Radiation Treatment For Testicular Cancer

Postby Corin » Fri Apr 29, 2016 11:59 pm

Dr. Seigle, Thank you in advance for making yourself available in this forum. My question involves a Stage 1 seminoma that has thus far been treated w/ an inguinal orchiectomy. The pelvic/abd CT was clear and we planned to proceed w/ radiation,  however a malpositioned and centrally located kidney has been revealed on CT. Due to the position of the kidney, it will now be partially in the radiaton field and at risk for damage. I know the statistics and what watchful waiting involves if I choose to not proceed w/ radiation due to concern for my renal function. BUN/ Creat/ GFR are normal at 36 years old. My main question is what are the risks for damaging my kidney(I realize the vast majority of people w/ one kidney do just fine) Can I get your expert consultation/opinion on this matter for someone who has a background as a nurse practitioner in the critical care setting. Are there any case studies, research on this? What have you seen or what can you tell me to help make an informed decision?

Many thanks,

Shannon
Corin
 
Posts: 60
Joined: Mon Jan 06, 2014 8:40 pm


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