The importance of the blood levels of homocysteine, folic acid and vitamin B12 in children with malignant diseases.

PURPOSE: Hyperhomocysteinemia is associated with carcinogenesis. Since only little research exists on hyperhomocysteinemia and malignancy in children, the possible relationship between homocysteine and childhood malignancies remains unknown. The aim of the present study was to determine the serum levels of homocysteine, folic acid and vitamin B12 in children with malignant and benign tumors prior to therapy (surgical treatment and/or chemotherapy), and after treatment of malignant diseases as well. METHODS: Forty-six children with newly diagnosed malignant diseases (solid tumors and lymphoproliferative/myeloproliferative (LP/MP) malignancies) and 6 children with benign tumors were included in the present study. The patient age ranged between 2 months and 18 years. RESULTS: Significantly increased homocysteine concentrations were identified in children with malignant diseases compared with those with benign tumors (p<0.01). The plasma concentration of homocysteine in children with malignant diseases decreased significantly following treatment (p<0.05). Before treatment, the concentration of folic acid in children with malignant solid tumors was significantly higher than in children with malignant LP/MP diseases (p<0.01). Following treatment, the concentration of folic acid was significantly decreased (p<0.05) in children with malignant solid tumors, while it was not significantly increased in children with malignant LP/MP diseases (p<0.05). The concentration of vitamin B12 in children with malignant diseases (solid tumors and LP/MP diseases) increased significantly following treatment (p<0.01), while it increased substantially (p<0.01) in patients with solid malignancies following treatment. CONCLUSION: Homocysteine could be a marker of malignancy in children. Further research is needed to establish the importance of homocysteine, folic acid and vitamin B12 in pediatric malignant diseases.

The significance of HER-2 amplification and the size and type of pathological unicentric, initially operable clinical stage I and IIA/IIB breast cancer, in determining the treatment strategy.

PURPOSE: In order to determine the initial treatment strategies for primary operable unicentric breast cancer, the possible relationships of the amplification of human epidermal growth-factor receptor-2 (HER-2), with age, menstrual status, tumor pathological size (pT), histopathological tumor type (HP) and kind of surgical treatment were studied. METHODS: Analysed were 301 patients treated initially by surgery in the period 2006-2009. HP tumor type, pT and HER-2 status (using firstly immunohistochemistry and then chromogenic in situ hybridization/CISH) were determined. The patients were divided into 2 subgroups according to the presence (CISH+)/absence (CISH-) of HER-2 amplification. RESULTS: Data on pT and HER-2 analyses were available for 293/301 (98.3%) patients with ductal (DC) and lobular carcinoma (LC). Amplification of HER-2 was found in 66 (21.9%) patients. No significant difference between the two subgroups regarding age (p=0.08), menstrual status (p>0.05) and kind of operation (p>0.05) was found. HP showed statistically significant difference between DC (55; 83.3%) and LC (11; 16.7%) patients with HER-2 amplification (p<0.01). Further HP analysis of the type of cancer within the pT category as a subgroup showed significantly higher frequency of HER-2 amplification in DC patients for pT1 (p<0.01) and in pT2 + pT3pN0 (p<0.05) compared with patients with LC. CONCLUSION: This study showed a significantly higher incidence of HER-2 amplification in DC tumors, especially in pT1 and pT2, than in LC, which may influence the options in treatment strategies in primary unicentric operable DC type of breast cancer.

Outcome of childhood brain tumors in Serbia.

PURPOSE: To present the results of treatment for childhood brain tumors in Serbia. METHODS: The medical records of patients with brain tumors diagnosed and operated at the Institute of Neurosurgery, Clinical Center of Serbia and treated with postoperative radiotherapy and chemotherapy at the Institute of Oncology and Radiology of Serbia, Belgrade, between January 1995 and December 2004, were reviewed. Of the 247 patients who were identified, 212 formed the basis of this study. Overall survival (OS) was determined by the Kaplan-Maier method, using log-rank test for comparisons. RESULTS: With a mean follow up of 46.9-33.6 months (range 7-120), the 5-and 8-year OS rates were 70.0% and 61.5%, respectively. At the time of evaluation 119 (60.1%) patients had no evidence of disease. Among 79 patients who failed therapy, most of them (n=61; 77.2%) had local failure only. According to histologic tumor type most of them (n=27; 34.2%) were in the group of malignant medulloblastoma. Girls had better survival than boys, but without statistical significance (p=0.185). Also, no significant difference in survival in relation to age was seen (p=0.291). Patients with supratentorial tumors had significantly better survival than those with infratentorial localizations (p=0.036). Patients with low grade astrocytomas had significantly better survival than malignant gliomas, ependymomas and primitive neuroectodermal tumors (PNETs) (p=0.0001). CONCLUSION: OS rates were concordant with the results of other modern series. Although the survival rates were encouraging, there is still significant room for improvement in the management of childhood brain tumors.

Psychological well-being in advanced NSCLC patients in Serbia: impact of sociodemographic and clinical factors.

UNLABELLED: Patients with advanced non-small cell lung cancer (NSCLC) usually undergo toxic treatment (chemotherapy and/or radiotherapy). They can experience devastating effects of illness and therapies on their psychological and emotional well-being. On the other hand, untreated psychological distress is associated with reduced quality of life and inadequate palliation of physical symptoms.
In order to estimate frequency of anxiety and depressive symptoms and influence of demographic, socioeconomic and clinical factors on psychological well-being, we performed this cross-sectional study in group of 100 patients with advanced stage of disease. Symptoms of anxiety and depression were assessed using the Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating scale (HDRS). Health-related quality of life data are obtained by EORTC QLC C30 and SF 36.
Patients with poor performance status (PS) experienced significantly more anxiety and depressive symptoms (p=0.001) and worse emotional (p=0.001) and mental functioning (p=0.001). Treated patients had significantly better mental (p=0.011) and emotional (p=0.001) functioning in compared to newly diagnosed ones. Somewhat unusual, unemployed participants reported significantly less anxiety (p=0.029) and depressive (p=0.002) symptoms, better mental (p=0.030) and emotional functioning (p=0.007). Additionally, nausea and vomiting adversely affected mental health and emotional functioning and correlated significantly positively with HARS and HDRS scores.
Our findings suggest significant impact of some disease-related factors (PS, active treatment) and treatment-related factors (chemotherapy -induced nausea and vomiting) on psychological well-being of patients with advanced NSCLC. This should be taking an account when appropriate interventions are planned. KEYWORDS: lung cancer, anxiety, depression, quality of life, chemotherapy, chemotherapy-induced nausea and vomiting.

Health-related quality of life in lung cancer patients in Serbia: correlation with socio-economic and clinical parameters.

The objective of this study was to assess health-related quality of life (HRQoL) in patients with advanced non-small cell lung cancer (NSCLC). In Serbia, there is the lack of available data on HRQoL in lung cancer patients. The special attention in our study has been paid on relationships between socio-economic factors and HRQoL. This cross-sectional study was undertaken in group of 100 NSCLC patients with advanced stage diseases. HRQoL was measured using three standard instruments: 36-item Short Form Health Survey, EORTC QLQ-C30 and its Lung Cancer module (EORTC QLQ-LC13). Unexpected, highly educated patients reported significantly worse social functioning (P=0.044), and higher degree of financial difficulties (P=0.047), in comparison with less-educated. Also unusual, unemployed patients had significantly better HRQoL in all domains and significantly lower symptom distress. Significantly better overall HRQoL (P=0.043), social (P=0.024), emotional (P=0.001) and mental functioning (P=0.011) were observed in patients treated with chemotherapy in comparison with newly diagnosed ones. In addition, the most prominent side effects of chemotherapy were nausea and vomiting, and all QoL domains correlated significantly with them. Patients who undergo active treatment improve their HRQoL but chemotherapy-induced emesis adversely affects many HRQoL domains. Additionally, HRQoL is highly dependent on patient's socio-economic characteristic.

Do the time to chemotherapy response and the dose intensity have an impact on patient outcome in advanced non-small cell lung cancer?

PURPOSE: To better define the importance of early response rate (RR) as well as dose intensity (DI) in advanced non small cell lung cancer (NSCLC) patients treated with platinum-based combination chemotherapy. PATIENTS AND METHODS: Analysed were stage IIIB and IV NSCLC patients included in 4 prospective clinical trials. All of them were treated with cisplatin 120 mg/m2 (the majority of patients) or carboplatin 500 mg/m2, and since 2000 with AUC 5 (the minority of patients) with second-generation platinum-based regimens. Responding patients (complete response/CR and partial response/PR) were divided into 4 different categories, depending on the time when response was first registered. DI and total dose (TD) of cisplatin was calculated for 93 patients with response or stable disease (SD). RESULTS: Among 362 patients analysed, 117 (32%) were responders. Although "early" responders (54 patients after the 2nd cycle, median survival 10 months; 42 patients after the 3rd cycle, median survival 11 months) lived shorter than "late" responders (11 patients after the 4th cycle median survival 12 months; 10 patients after the 5th cycle, median survival 19 months), these differences were not statistically significant, neither in terms of overall survival (OS) nor in time to progression (TTP). DI in patients with CR+PR+SD was 30 mg/m2/week (median). TD of cisplatin in CR+PR patients was 577 mg, whereas it was 475 mg in patients with SD (p=0.004). These differences followed significant differences in the number of the cycles received and median survival between CR+PR vs. SD patients. CONCLUSION: Early response was not associated with better survival, DI in SD patients did not differ from responding patients, but responding patients received more cisplatin and lived longer.

[Pediatric brain tumors--diagnostic and treatment].

During the period 1995-2004 we treated 212 patients (pts) with brain tumors. There were 133 boys and 79 girls, aged from 2,5 yrs up to 18 yrs (Me = 9, 7 yrs). The majority of pts were in age group (4-16) yrs-179 pts. Supratentorial tumors were diagnosed in 118 pts vs. infratentorial 94 pts. Therapy involved surgery, postoperative radiotherapy with or without chemotherapy. Survival rates were calculated using Caplan-Meier method and differences between curves with log-rank test. During the follow-up period from 1 to 9 year (Me = 3 yrs) 5-year disease free survival rate was 55.7%. 79 pts failed to therapy. There was no statistically significant difference in survival according to sex (p = 0.123) and age (p = 0.367). Pts with supratentorial tumors had statistically significant better survival (p = 0.036). Pts with histologic type low grade astrocitomas had statistically significant better survival than malignant gliomas, ependymomas and PNET (p = 0.0001). Surgery, postoperative radiotherapy and chemotherapy in selected cases are efficient therapeutic approach for pediatric brain tumors.

Risk factors for breast cancer: is ionizing radiation among them?

All human beings are exposed to the influence of ionizing radiation from natural, medical and other artificial sources. Therefore, the influence of radiation as a risk factor for cancer development has been among the most studied external factors over the last 6 decades, particularly with respect to radiosensitive tissues and organs. It has been known that female breast tissue is highly sensitive to the carcinogenic effects of radiation, particularly when exposure takes place at younger age. All women are exposed to low doses of radiation for several common reasons (kind of occupation, medical diagnostic procedures, residence background radiation) whose effects on breast cancer development cannot be documented, and thus it is believed that ionizing radiation is not primary or major risk factor leading to development of breast cancer. Radiobiological studies revealed a specific event caused by radiation through recognition of the critical target in radiation-induced carcinogenesis. Accordingly, mutagenic and carcinogenic effects of ionizing radiation are evidenced both in vitro and in vivo, although the incidence of radiation-induced cancers is low. The highest risk of radiation- induced breast cancer is evidenced in the sub-population of female patients who have undergone radiotherapy for either malignant or non-malignant diseases, including benign breast diseases in their childhood or young age. Therefore, as a means of prevention in this group of population, indications for application of ionizing radiation, both diagnostic and therapeutic, should be highly selective, meaning that radiation should be applied only if the possible benefit outweighs the risk.

[Mammography in detection clinically occult breast carcinoma].

AIM: The significance of mammography in detection of nonpalpable breast cancer MATERIAL AND METHODS: This prospective study was conducted at the Institute for oncology and radiology of Serbia in Belgrade. It involved 198 asymptomatic women with performed screening mammography, 154 specimen mammography, out of wich 38 had stereotaxic mark, "ex tempore" biopsy, while 44 women had "ex tempore" biopsy and adequate surgery. RESULTS: Screening mammography revealed suspect microcalcifications in 148 cases, impaired structural tissue in 59 and focal condensation in 55 cases. Histologic examination verified breast carcinoma in 80 patients with very statistical significance of ductal type, especially comedo subvariant (p < 0.001). Pleomorphic microcalcifications smaller than 0.5 mm of grouped or segmented form are statistically very significant for malignity (p < 0.001) as well as associated microcalcifications with altered architectony and focal tissue condensation (p < 0.001). CONCLUSION: Mammography has great significance in detection of occult breast carcinoma which are not only preinvasive, but olso microinvasive and invasive. This fact leads to the neccesity of introduction of legal obligation for mammography screening, especially for women aged between 50 and 70 years.

Late relapse of pediatric medulloblastoma.

Medulloblastoma (MB), the most common malignant brain tumor of childhood, is classified according to pathomorphologic characteristics in the group of central nervous system embryonal tumors, but both its pathogenesis and biologic behavior remain unknown. In addition, the relationship of MB to other embryonal brain tumors is debated and response to therapy is difficult to predict. The authors report an uncommon case of unfavorable late relapse, local as well as distant, in a 26-year old male patient, who was free of disease and without treatment-related morbidity for fifteen years after combined therapy for pediatric MB.

[Medullary carcinoma of the thyroid gland: effect of postoperative transcutaneous radiotherapy on local control and results of treatment]. / Medularni karcinom stitaste zlezde: uticaj postoperativne transkutane zracne terapije u lokalnoj kontroli i rezultatima lecenja.

In the period of Octo. 01, 1987. up to Dec. 31, 1998. retrospective-prospective, non-randomized study was conducted at IORS, which included 36 patients diagnosed with thyroid gland medullar cancer. Our study had the following aims: evaluation of treatment results following probability of total survival, survival without signs of disease and disease-free interval until local recurrence of the disease and influence of parameters of transcutaneous radiotherapy (intensity of total tumor dose and length of disease-free interval from date of performed operation to beginning of radiotherapy). After finished treatment, median of the patient follow-up was 37.75 months (3.5 up to 141 months); probability of total five-year survival was 62.61% and of 10 year survival was 23.48%. Probability of 5-year survival, without signs of disease was 37.13%, and of 10-year survival 18.56%. As to radiotherapy parameters intensity of total therapy dose was statistically insignificant, while time interval to beginning of transcutaneous radiotherapy, shorter than 2 months, was statistically significant in relation to prognosis of disease outcome.

[Radiotherapy in malignant tumors of the thyroid gland]. / Radioterapija malignih tumora stitaste zlezde.

The primary treatment of thyroid gland malignoma is surgery. Success of radiotherapy depends of extent of the previous surgery treatment. The types of radiotherapy are: curative (prophylactic and postoperative) and palliative. Tumor dose and radiotherapy tehnique depend on histologica type, extent of the previous surgery treatment, curative or paliative intent and general condition of patient, and they are from 40 Gy to 65 Gy by conventional fractionation. The basis of radiotherapy treatment planning and choice of radiotherapy treatment technique in survey of the region of interest by imaging procedure. On the basis of those data we determine therapeutic volume and structure of risk (spinal cord, lung) and protection of the risky structures is planned.

[Role of radiotherapy in combined therapy of soft tissue sarcoma in children and adolescents]. / Uloga radioterapije u kombinovanom lecenju sarkoma meki tkiva kod dece i omladine.

Over last decades with modern approach to combined treatment of soft tissue sarcoma in children and adolescents, with effective systemic chemotherapy and adequate local control most frequently with conservative surgery and radiotherapy, or radiotherapy alone, results of treatment from 20% of a three-year overall survival to 75% were improved significantly. Nevertheless, combined treatment involves risk of acute radiation reactions and late side effects, so there is a need for precise radiotherapy planning with optimal schedule of fractionating, adequate radiation volume and optimal tumour dose. The purpose of our study was to evaluate the results of combined treatment of soft tissue sarcoma, role of radiotherapy in local control use of the optimal tumour dose and assessment of acute radiation reactions in an examined group of patients. A retrospective clinical study involved 47 patients treated with radiotherapy at the Institute of Oncology and Radiology of Serbia over the period from 1990 to 1997. The most frequent tumour sites were the head and neck and the extremities. According to the IRS classification most patients were in CS III (21 patients). Forty patients had histological type--Rhabdomyosarcoma (Table 1). All patients were treated with chemotherapy, and local therapy were surgery and radiotherapy or radiotherapy alone. Thirty one patients were operated on. All 47 patients were treated with radiotherapy; in 37 patients as primary treatment and in 10 patients as therapy for local relapse. Radiotherapy was planned according to tumour size, tumour site, age of the patient and type of surgery. Tumour dose from 45 Gy to 60 Gy was given in cases with a residual tumour. Lower tumour doses were used in cases of postoperative microscopic disease, in certain cases of local relapse treatment or when the size of residual tumour and patient's age allowed no delivery of higher tumour doses. Standard fractionating regimen was given to all patients, with daily fractions from 150 cGy to 214 cGy, five times per week. The majority of patients (24) were treated on Linear Accelerator machine with X photons of 10 MeV energy and with X photons of 6 MeV energy (13 patients) (Table 2). Statistical data processing was made by the following methods: Kaplan-Meier for survival rate and Long-rang and Wilcox test for assessment of the statistical significance in survival difference. In our group of patients treated over the period from 1990 to 1997 a three-year overall survival was 59.15%, and disease free survival was 46.68% (Figure 1). There were 21 patients (44.7%) without signs of the disease, 12 patients had a local disease (25.5%), 9 patients had both local and metastatic disease (19.1%) and 5 patients had only metastatic disease (10.50%). In the group of 47 patients who received radiotherapy, 24 patients received a tumour dose from 45 Gy to 60 Gy and 23 patients a tumour dose from 32 Gy to 45 Gy. The group of patients treated without tumour dose more than 45 Gy had a significantly better overall survival rate (p = 0.002) (Figure 2). Although the obtained results are in agreement with data from literature, a critical analysis is necessary. Namely, in addition to the group irradiated with a tumour dose from 32 Gy to 45 Gy, because of the postoperative microscopic disease, certain number of patients was irradiated with a "lower" dose because of an objective impossibility to administer a "higher" dose or this dose was planned for palliative reasons. The tumour dose of 45 Gy was delivered to 6 of 10 patients treated for local relapse. The tumour dose of 45 Gy was also used in four patients in CS IV, in two subjects for local control and in two as a palliative treatment. Seven patients in CS III received a tumour dose of 45 Gy, because the age of children, tumour site and tumour size permitted no higher tumour doses. That is when planning an adequate local therapy one must have in mind the initial tumour size, type of administered systematic chemo

Neck dissection in the management of regional metastases in patients with undifferentiated nasopharyngeal carcinomas.

Residual regional disease after the primary treatment of nasopharyngeal carcinoma is still considered to be a therapeutic problem. The limitations of prophylactic radical radiation, further doses of irradiation as a useful salvage procedure, and the effects on vital structures were the reasons that we employed a therapeutic protocol consisting of radical neck dissection after 40 Gy of radiotherapy and a full tumor dose after surgery. The initial treatment consisted of chemotherapy. Between 1977 and 1991 surgical removal of residual neck metastases was performed in 44 patients with undifferentiated nasopharyngeal carcinomas who had regional metastases at the time of diagnosis. Fourteen patients (group A) had radical neck dissections after initial chemotherapy (using doxorubicin, etoposide, bleomycin and/or 5-fluouracil) and between two courses of locoregional radiotherapy. The remaining 30 patients (group B) were operated on after finishing chemotherapy and locoregional radiotherapy (group B 1) or receiving only full-dose locoregional radiotherapy (group B 2). All patients had histopathologically proven complete remission of primary tumors before neck surgery. The five-year survival rates for group A were 78%, 40% for group B 1 and 27% for group B 2. There were statistically significant differences between groups A and B (P < 0. 01), but not between groups B 1 and B 2. In group A one patient died from subsequent distant metastases and two from local tumor recurrences. Twenty patients died in group B, regional relapses occurred in 40% of the patients in group B 1 and 33% in group B 2, while distant metastases developed in 40% of group B 2. These findings again showed that radical neck dissection was an effective approach for controlling neck disease. When performed after initial chemotherapy and between two courses of radiotherapy, surgery significantly improves the prognosis of patients with positive regional lymph nodes at the time of diagnosis.

Growth hormone secretagogues in pathological states: diagnostic implications.

The identification and cloning of the receptor for synthetic growth hormone (GH) secretagogues, even before the endogenous ligand has been identified or its precise physiological role established, suggests that there is a novel target of action for this class of drug. In an attempt to select patients who will benefit from GH treatment, GH secretagogues are being evaluated for their usefulness in diagnosing GH deficiency. The effects of GH-releasing peptides (GHRPs) on GH release as a function of age and metabolic status, and in different neuroendocrine pathologies, are described, as are the different mechanisms of action, potency and reproducibility of the response to GHRPs compared with GH-releasing hormone (GHRH). GHRPs offer the advantage over GHRH in natural models of deranged GH secretion in that, in various metabolic states (e.g. obesity, anorexia nervosa and non-insulin-dependent diabetes mellitus), the GH response to GHRH is more impaired than it is to GHRPs. However, in some neuroendocrine pathologies, the reverse is true. Thus, both secretagogues provide separate information on the physiological status of somatotrophs.

[Palliative irradiation in the treatment of breast carcinoma]. / Palijativno zracenje u lecenju karcinoma dojke.

It is considered that in 30% of female patients with breast cancer a certain form of evolutive disease occurs within 5 years from documented diagnosis. In these female patients, 58% develop distal metastases. Thus, a great number of these female patients enter the phase when hope for recovery is small. Then supportive therapy is used. It's main task is to alleviate the life of these patients. Palliative radiotherapy is one of the main elements of this therapy. It is directed to decrease the pain, and bleeding, to prevent fractures and decompression of the spinal cord, as well as many other evolution consequences of local or distal disease. The correct and timely definition of indications for radiotherapy, the optimal planning and conduction of the therapy should take into account the patient's characteristics as well as the main postulates on which radiotherapy is based. In this way the satisfying effects on patients with disseminated breast cancer, may be expected.

[Local recurrence after preoperative irradiation and radical surgery in patients with locally advanced breast carcinoma (clinical stage A)]. / Lokalni recidiv kod preoperaciono zracenih i radikalno operisanih bolesnica s lokalni napredovalim karcionomom dojke (klinicki stadijum tredji-A).

The rationale preoperative irradiation is expressed by the sound: eradication of sensitive tumour cells at the periphery of a lesion making complete resection more likely and dissemination of tumour cells by operative manipulation less likely. The dose of irradiation required is approximately 80 to 85% of the dose needed to permanently control the palpable disease, a dose which does not interfere with subsequent mastectomy, if 3 to 4 weeks elapse between the termination of irradiation and mastectomy. One hundred fifteen consecutively examined patients with stage IIIa breast cancer were treated over the period from January 1985 to December 1987 at the Institute of Oncology and Radiology, Belgrade, Serbia. We were interested in the local control of preoperatively irradiated and radically operated patients with the median follow-up of 82 months. Fifteen patients had local recidives, the local control was made in 87%, in the interval between 6 and 66 months (median 18 months). We analyzed the correlation between the local control and the grade of malignancy (GM) of the axillary lymph node and the T status of the tumour. GM was more important than T. Based on our results and on those of other authors, we believe that this multimodal regimen, which includes preoperative irradiation, radical mastectomy and adjuvant cheme-hormonotherapy, is satisfactory for patients with stage IIIa primary breast cancer.

Undifferentiated nasopharyngeal carcinoma in children: a report of four cases.

Nasopharyngeal carcinoma in early stages in children is a highly curable neoplasm. The major cause of treatment failure is the development of distant metastases, predominantly in advanced stages. This paper reports about four young patients with undifferentiated nasopharyngeal carcinoma treated with preradiation chemotherapy, locoregional radiotherapy and maintenance chemotherapy up to a total period of two years. Treating these four children, we noticed that preradiation chemotherapy caused satisfactory regression of the primary tumor. Three patients are still without signs of disease after 28 to 88 months and one died due to tumor progression. Further studies have to confirm our observations and support research in designing the optimal combination of effective chemotherapeutic agents and radiotherapy.

[Treatment-related complications after radiotherapy for testicular malignancies--seminoma stage I and II]. / Komplicacije radioterapije malignih tumora testisa (seminoma prvog i drugog stadijuma.

Significant improvement in survival of patients treated for testicular seminoma, particularly in early stages of disease, shows that combined treatment can cause both acute reactions and/or late adverse effects in some cases. These rare complications may have great impact on quality of life of long-term survivors. The aim of our investigation was to assess incidence and intensity of sequelae in a group of 113 patients receiving postoperative radiotherapy for testicular seminoma stage I and II over the period 1982-1988, as well as to determine possible risk-factors. The follow-up period was 24-84 months (Me = 68.4 m). Acute symptoms were noticed in 19.4% of patients, all of them being of a mild degree and no case required a delay of treatment. Long-term complications developed in 8.8% of patients. During the follow-up period two secondary cancers were detected and histologically proved. These results are acceptable and similar to other published data, and in relation to the good prognosis with combined treatment, it can be concluded that the infradiaphragmatic radiotherapy is the obliged part of management for testicular seminoma in early stages.