Radiation Therapy for Testicular Cancer

Testicular cancer is a relatively rare but highly treatable cancer that develops in the testes, the male reproductive glands responsible for producing sperm and testosterone. The majority of cases involve germ cell tumors, which originate in the cells that produce sperm. Germ cell tumors are broadly classified into two main categories: seminomas and non-seminomas. Seminomas typically grow slowly and respond well to radiation therapy, while non-seminomas tend to be more aggressive and may require chemotherapy.

Although the exact cause of testicular cancer is not always known, certain factors may increase the risk, including an undescended testicle (cryptorchidism) and a family history of testicular cancer. The condition primarily affects young and middle-aged men between the ages of 15 and 44.

Warning signs of testicular cancer can include a dull ache in the groin, a painless lump or swelling in one testicle and a sensation of heaviness in the scrotum. In some cases, the tumor may not cause noticeable symptoms until it has progressed and invaded another part of the body. The diagnostic process usually begins with a physical examination, scrotal ultrasound and blood testing for certain tumor markers. Initial diagnostic testing may be followed by further imaging studies to check for possible cancer spread.

Testicular cancer treatment can vary based on the type and stage of the tumor and the patient’s overall health. Common options include surgery, radiation therapy and chemotherapy.

When is radiation therapy used for testicular cancer?

Radiation therapy for testicular cancer is primarily used to treat seminomas, which typically develop slowly and respond well to radiation. It is generally not used for non-seminomas, which tend to be fast-growing and usually require more aggressive treatment, such as chemotherapy.

Radiation therapy for testicular cancer may be considered:

After surgery for early-stage seminoma

Once the affected testicle is removed through a radical inguinal orchiectomy, radiation therapy may be used to target microscopic cancer cells that could remain in the retroperitoneal lymph nodes, which are located in the lower back and abdomen. In stage 1 and stage 2 seminomas, when the cancer is confined to the testicle and nearby lymph nodes, this treatment approach can help lower the risk of recurrence.

If testicular cancer recurs in nearby lymph nodes

If a testicular seminoma returns after initial treatment and the recurrence is limited to the surrounding lymph nodes, radiation therapy may be used as a second-line approach to treat the affected tissues and help prevent further cancer spread.

If chemotherapy is not feasible

Radiation therapy may be an alternative for a patient who is not a good candidate for chemotherapy due to a medical reason or personal preference. The decision will depend on the stage of the tumor and the patient’s overall health.

What does radiation therapy for testicular cancer involve?

Several types of radiation therapy may be used in the treatment of testicular cancer, each offering unique advantages depending on the type and stage of the tumor and the overall treatment goals. Options may include:

External beam radiation therapy (EBRT) for testicular cancer

EBRT uses a specialized machine (linear accelerator) to direct high-energy X-rays at the tumor from outside the body. For testicular cancer, the radiation is often aimed at the retroperitoneal lymph nodes, a common site of early cancer spread. Treatment is usually delivered in daily sessions (Monday through Friday) over two to three weeks. Each session is brief and painless, typically lasting only a few minutes, although additional time will be needed beforehand for positioning and setup.

What are the possible side effects of external beam radiation therapy for testicular cancer?

The side effects of EBRT for testicular cancer are generally mild and temporary. Some patients may experience:

• Fatigue
• Nausea or upset stomach
• Diarrhea
• Skin irritation in the treated area
• Irregular bowel movements

What are the risks and possible complications of external beam radiation therapy for testicular cancer?

Though uncommon, potential risks of EBRT for testicular cancer include:

• Long-term fertility issues (if proper precautions are not taken)
• Low sperm count
• Slightly increased risk of developing a secondary cancer in the radiation field many years later
• Damage to nearby organs, such as the intestines, kidneys and bladder

What to expect during recovery from external beam radiation therapy for testicular cancer

Most side effects of EBRT for testicular cancer begin to resolve within a few weeks after the treatment ends. During recovery, the patient will be encouraged to rest, stay hydrated and maintain a balanced diet. Follow-up visits will be scheduled to monitor healing and assess the treatment response.

How effective is external beam radiation therapy for testicular cancer?

EBRT can be highly effective for treating seminomas, particularly in stages 1 and 2. This treatment approach can offer excellent cancer control and reduce the risk of recurrence after surgery. Studies show that cure rates for early-stage seminomas treated with radiation therapy exceed 95%.

Intensity-modulated radiation therapy (IMRT) for testicular cancer

IMRT is an advanced form of external beam radiation therapy that allows for highly precise shaping of radiation beams, which are modulated in intensity during treatment to better conform to the dimensions of the tumor. This technology enables accurate tumor targeting while minimizing exposure to the surrounding healthy tissues. Like standard EBRT, intensity-modulated radiation therapy is delivered externally in daily outpatient sessions scheduled over a few weeks.

What are the possible side effects of intensity-modulated radiation therapy for testicular cancer?

Due to the heightened precision of IMRT, the side effects are usually minimal. However, some patients may still experience:

• Tiredness
• Mild digestive issues
• Skin redness or rash
• Minor changes in bowel habits

What are the risks and possible complications of intensity-modulated radiation therapy for testicular cancer?

The potential complications of IMRT are similar to those of traditional external beam radiation therapy, but the risk may be reduced due to improved tissue targeting. Possible short– and long-term effects include:

• Fertility issues
• Slightly increased risk of secondary cancer
• Radiation exposure to nearby organs

What to expect during recovery from intensity-modulated radiation therapy for testicular cancer

IMRT is generally well-tolerated, with any side effects usually resolving within a few weeks. Most patients notice a gradual improvement in their energy and appetite. Ongoing follow-up care will be necessary to evaluate the treatment outcome and detect any signs of recurrence.

How effective is intensity-modulated radiation therapy for testicular cancer?

IMRT can be just as effective as standard external beam radiation therapy for seminomas, but it offers better tissue sparing, making it a particularly good option for tumors situated near vital or sensitive organs. This treatment approach can be especially beneficial for a patient with anatomical variations or prior abdominal surgery.

Stereotactic body radiation therapy (SBRT) for testicular cancer

SBRT is a highly focused form of radiation therapy that delivers a concentrated dose of radiation to a precise target, often in five or fewer sessions. Using imaging guidance and computerized planning, the physician can pinpoint the tumor with sub-millimeter accuracy. Although stereotactic body radiation therapy is not commonly used for primary testicular tumors, it may be considered in select cases of recurrent or metastatic cancer when surgery and chemotherapy are not feasible.

What are the possible side effects of stereotactic body radiation therapy for testicular cancer?

Due to the high dose of radiation delivered during each treatment session, some patients may experience:

• Localized pain or discomfort
• Fatigue or weakness
• Skin sensitivity
• Gastrointestinal distress

What are the risks and possible complications of stereotactic body radiation therapy for testicular cancer?

Possible complications of SBRT for testicular cancer include:

• Inflammation of the surrounding tissues
• Mild bleeding or ulceration in the gastrointestinal tract
• Damage to adjacent critical structures

What to expect during recovery from stereotactic body radiation therapy for testicular cancer

Because SBRT is usually delivered in fewer sessions than traditional radiation therapy, the overall treatment and recovery time may be shorter. Side effects, if any, typically peak a few days after treatment ends and then gradually improve. Most patients can resume their normal activities quickly with minimal downtime.

How effective is stereotactic body radiation therapy for testicular cancer?

SBRT is not a standard treatment for primary testicular cancer. However, for select patients with isolated metastatic tumors or recurrent cancer, it can offer effective local control. Sometimes, stereotactic body radiation therapy is used as part of a broader treatment strategy in consultation with a multidisciplinary cancer team.

Benefit from world-class care at Moffitt Cancer Center

Moffitt is a high-volume cancer center, and our radiation oncologists are skilled and experienced in utilizing the latest radiation delivery techniques and technologies. We also have a robust clinical trials program, providing our patients with unique opportunities to be among the first to benefit from promising new radiation treatments that are not yet available elsewhere. All of this translates to superior outcomes and better quality of life for our patients.

If you would like to learn more about radiation therapy for testicular cancer, you can request an appointment with a specialist in our Urologic Oncology Program by calling 1-888-663-3488  or submitting a new patient registration form online. We do not require referrals.