Complications of radiation therapy

Following orchiectomy, a treatment for early stage seminoma is retroperitoneal radiation therapy (XRT). Seminoma is exquisitely sensitive to radiation and cure rates for low-stage disease approach 100%. Acute side effects are predominantly gastrointestinal, with mild nausea being reported in approximately half of the patients undergoing XRT [104,105]. Less frequently reported side effects during therapy include diarrhea and cutaneous toxicity. Significant incidences of long-term morbidity in regards to secondary malignancies as well as cardiac disease have been recognized [106,107]. In a substantial cohort of patients treated over a 48-year period at a single institution, standardized mortality ratios for cancer-specific and cardiac-related deaths were 1.61 and 1.91 respectively, indicating significant excess risk in this post-XRT population as compared to controls. Subdiaphragmatic radiotherapy to the para-aortic and ipsilateral iliac has also been found to have a greater deleterious effect on fertility than chemotherapy [93].

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