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Aims: To report clinical results in patients with testicular seminoma treated with postoperative radiotherapy with regard to survival, acute and late toxicity, and risk of second malignancy., Materials and Methods: 176 stage I-Il testicular seminoma patients treated with radiotherapy from 1964 to 1994 at the Radiotherapy Division of Pisa University, using 60Co or Linac, were analyzed retrospectively. The follow-up ranged from 0.13 to 32.37 years, with a median of 12.1 years. The observed numbers of second malignancies were compared with those expected, taking into account age, sex, and incidence rates from the Tuscany Tumor Registry., Results: Overall and specific survival at 10-15 years were 89-82% and 93-92%, respectively. Multivariate analysis revealed a significantly better survival in patients younger than 50 years and in those treated with Linac. Severe late sequelae occurred in 8% of the patients. Sixteen second malignancies were observed (14 solid tumors and 2 leukemias); median latency was 13 years (range, 3-27) and the observed/expected ratio 1.4 (P not significant). Solid cancers were localized in the bladder (2), kidney (2), skin (2), stomach (1), prostate (1), lung (1), larynx (1), uvea (1) and contralateral testicle (1); 1 patient presented an intestinal carcinoid and 1 a metastasis from an unknown primary. The risk of a second malignancy was higher in the patient group receiving less than 4000 cGy (observed/expected, 2.8; P = 0.015)., Conclusions: The study confirmed the high cure rate in stage I-II seminomas after postoperative radiotherapy. Incidence of a second malignancy was higher than expected, but the difference was not statistically significant.

From 1958 to 1974, 129 patients with pure seminoma of the testis were admitted to the Institute of Radiology, University of Florence. Sixty-two were in Stage I, 36 in Stage II A, 23 in Stage II B, 3 in Stage III, and 5 in Stage IV, Para-aortic and ipsilateral iliac nodes were treated in all cases with doses ranging from 3000 to 4200 rads. In the treatment of the supradiaphragmatic area, uniform criteria were not adopted. Out of 124 cases in Stage I, II A and B, and III, 17 suffered a replase; aall relapsed cases died except for one. Site and cause of the failures were analyzed. Prophylactic irradiation of the mediastinum and supraclavicular area appears to lower the probability of recurrence in Stage II. Doses over 3500 rads may be necessary to destroy large metastases. The presence of nonseminomatous areas in the seminoma showing inadequate regression after radiotherapy must be suspected; an exploratory laparotomy should be indicated in such a case.

Coexistence of true systemic sarcoidosis and Hodgkin's disease has been reported as a very exceptional occurrence. In this paper a case observed at the Institute of Radiology of Florence is described of which the most interesting features were 1) sarcoidosis appeared 5 years earlier than Hodgkin's disease; 2) at staging lymphography the paraortic nodes appeared extensively enlarged and showed multiple filling defects; 3) at laparotomy the nodes removed were histologically affected by sarcoidosis only; 4) multiple foci of sarcoidosis were found also in the spleen and liver; 5) this feature led us to refrain from irradiating the abdomen; 6) one year later a further enlargement of paraortic nodes was observed; 7) a second laparotomy revealed Hodgkin's infiltration in the removed nodes; 8) irradiation of the inverted "y" field was followed by complete regression of the nodes and the patient is alive and well 2.5 years after the relapse.

Twenty patients with Hodgkin's disease limited to infradiaphragmatic (ID) nodes have been treated at the University and Hospital Radiotherapy Departments in Florence between 1960 and 1978. Clinicopathologic features and treatment modalities of these patients were reviewed and results compared with those of 2 similar series previously published by other authors. With respect to the patients with disease above the diaphragm, the ID presentation occurred more often in males in all the 3 reviewed series; a relative prevalence of the lymphocytic predominance histotype and of an older age was observed in 2 only of the 3 series; laparatomy seems unnecessary in lymphographic-negative patients. The analysis of therapeutic results suggests that inverted Y irradiation is a sufficient treatment when inguinal or lower iliac nodes only are affected; paraortic region and spleen involvement warrant a more radical program including the supradiaphragmatic irradiation or systemic chemotherapy.

From January 1960 to June 1974, 71 patients with a postsurgical relapse of endometrial adenocarcinoma have been referred to the Radiology Institute of the University of Florence. Eleven patients showed hematogenous metastases; the remaining 60 cases showed locoregional relapses and were treated with radiotherapy. Forty-eight patients, whose relapse was localized to the pelvis, vagina, inguinal nodes or perineal scar, were treated with a radical aim (4,500-6,000 rad in 5-6 weeks); the treatment was palliative in 12 cases with abdominal extrapelvic relapse. The therapeutic response was not evaluated in 8 patients lost to follow-up shortly after the treatment. In the cases treated with a radical scope, a complete regression was attained in 22 of 43 (51%); a survival rate of 16 of 43 (37%) was attained at 5 years. In 9 cases treated with a palliative aim, only subjective remission was attained, and no patient was alive one year after the therapy. The most favorable therapeutic response was attained in the vaginal relapses (50% survivors at 5 years) and the cases with a late recurrence (more than 3 years) after the initial surgery. No definite correlation was found between the prognosis of the relapse and the histological grading of the primary tumor.

The authors report on a consecutive series of 253 cases of seminoma of the testis followed with periodic chest X-ray examinations from a minimum of three to a maximum of 27 years. The detection rate of asymptomatic intrathoracic metastases (ITM) was considered together with the costs of the follow-up procedure. Chest X-ray follow-up is not advisable beyond one year from primary treatment, since most (14 of 18) ITM occur in the first year, the detection rate of ITM beyond this date is too low (0.11% patients/year), and the related costs are too high (over $130,000 per ITM detected). Chest X-ray follow-up is questionable even in the first year after primary treatment for Stage I cases because of the low detection rate (1.38% patients/year) and the high costs (over $14,000 per ITM detected), whereas it appears to be opportune in Stages IIA and IIB.